Management of women with polycystic ovary syndrome who experienced premature luteinization during clomiphene citrate treatment.
OBJECTIVE
To determine the preferred treatment modality in patients with PCOS who experienced premature luteinization during CC treatment.


METHODS
Prospective randomized study.


METHODS
Tertiary medical center.


METHODS
Twenty-two infertile women with PCOS demonstrating premature luteinization during at least two consecutive CC cycles.


METHODS
Randomized induction of ovulation either with FSH alone or with GnRH agonist combined with FSH for a single treatment cycle.


METHODS
Premature luteinization was defined as serum progesterone >1.5 ng/mL before hCG administration.


RESULTS
Premature luteinization occurred in eight of the 10 patients (80%) in group A and in two of the 12 patients in group B (16.6%). This result corresponds to the higher mean (+/-SD) progesterone level present in group A patients as compared to those in group B (2.0 +/- 1.2 ng/mL vs. 1.2 +/- 0.6 ng/mL, P=0.03). No pregnancies were achieved in group A, whereas the pregnancy rate per cycle observed in group B was 33.3% (4/12). On the day of hCG administration, the maximum mean (+/-SD) estradiol level was significantly lower (P<0.0001) in group A (210.6 +/- 37.9 pg/mL) than in group B (600.3 +/- 253.8 pg/mL). The treatment duration and the number of FSH ampules used did not differ between the groups.


CONCLUSIONS
Pituitary desensitization with GnRH analog in combination with FSH is superior to FSH-only treatment in PCOS patients who demonstrate premature luteinization during CC treatment.
Lidor
A L
AL
Reproductive Medicine and Infertility Clinic, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.
Goldenberg
M
M
Cohen
S B
SB
Seidman
D S
DS
Mashiach
S
S
Rabinovici
J
J
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D019468:Disease Management; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D007986:Luteinizing Hormone / Q000097:blood*; D008186:Luteolytic Agents / Q000627:therapeutic use*; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D017329:Triptorelin Pamoate / Q000627:therapeutic use*
D005300:Fertility Agents, Female; D008186:Luteolytic Agents; D017329:Triptorelin Pamoate; D002996:Clomiphene; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone