title: A randomized clinical trial of treatment of clomiphene citrate-resistant anovulation with the use of oral contraceptive pill suppression and repeat clomiphene citrate treatment.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness and endocrine response of oral contraceptive ovarian suppression followed by clomiphene citrate in patients who previously were clomiphene citrate resistant.
  
  
  METHODS
  Forty-eight patients from a private tertiary infertility clinic were assigned randomly prospectively to either group 1 (oral contraceptive/clomiphene citrate), which received continuous oral contraceptives followed by clomiphene citrate, or to group 2 (control) received no treatment in the cycle before clomiphene citrate treatment. On day 3, 17 beta-estradiol, follicle-stimulating hormone, luteinizing hormone, and androgens were assayed before and after treatment. Follicle growth, ovulation, and pregnancy were evaluated. The Student t test and analysis of variance were used for statistical significance.
  
  
  RESULTS
  The oral contraceptive/clomiphene citrate group had a significantly higher percentage of patients who ovulated and of ovulatory cycles and pregnancies. Significantly lower levels of 17 beta-estradiol, luteinizing hormone, and androgen levels were seen in the oral contraceptive/clomiphene citrate group, with no significant changes in group 2.
  
  
  CONCLUSIONS
  Suppression of the ovary with oral contraceptives results in excellent rates of ovulation and pregnancy in patients who previously were resistant to clomiphene citrate. The decreases in ovarian androgens, luteinizing hormone, and 17 beta-estradiol may be responsible for the improved response.
authors.affiliation: Bellingham In Vitro Fertilization and Infertility Center, WA 98225, USA.
authors.forename: Emmett F
authors.initials: EF
authors.lastname: Branigan
authors.forename: M Antoinette
authors.initials: MA
authors.lastname: Estes
mesh_terms: D000328:Adult; D000728:Androgens / Q000097:blood; D000858:Anovulation / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002996:Clomiphene / Q000008:administration & dosage / Q000627:therapeutic use*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000627:therapeutic use*; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D017211:Treatment Failure; D014463:Ultrasonography
chemical_list: D000728:Androgens; D003277:Contraceptives, Oral, Combined; D005300:Fertility Agents, Female; D002996:Clomiphene; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone