A comparative randomized multicentric study comparing the step-up versus step-down protocol in polycystic ovary syndrome.
BACKGROUND
The aim of the study was to evaluate follicular development and ovulation comparing the low-dose step-up and the step-down protocols, in women with clomiphene citrate (CC)-resistant polycystic ovaries.


METHODS
Eighty-three women were randomized, and treated with recombinant (r) FSH (Puregon) using either the step-up (n=44) or step-down (n=39) protocol. They were followed up for three cycles unless pregnancy occurred.


RESULTS
Monofollicular development occurred in 68.2% of the 85 cycles in the step-up group, as compared with 32% of the 72 cycles in the step-down group (P<0.0001). Hyperstimulation was statistically less frequent using the step-up procedure (4.7 versus 36%, P<0.0001). Both protocols used the same number of FSH units per cycle (951+/-586 versus 967+/-458 in step-up and step-down respectively, P=not significant). However, the duration of ovarian stimulation was statistically different (15.2+/-7.0 days in step-up versus 9.7+/-3.1 in step-down, P<0.001). Ovulation was observed in 70.3% of the cycles using the step-up procedure as compared with 51.3% using the step-down procedure (P<0.01). The cumulative rate of clinical gestations during the study did not differ between the two groups (38.6% in the step-up versus 30.8% in the step-down procedure).


CONCLUSIONS
The step-up protocol using rFSH (Puregon), is more efficient in obtaining a monofollicular development and ovulation than the step-down protocol, in women with CC-resistant polycystic ovaries. Although the duration of stimulation is longer, the rate of ovarian hyperstimulation is much lower using the step-up protocol.
Christin-Maitre
S
S
Reproductive Endocrine Unit, EA 1533, Hôpital Saint-Antoine, 75012 Paris, France. sophie.christin-maitre@sat.ap-hop.paris.fr
Hugues
J N
JN
D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology; D006080:Ovarian Follicle / Q000187:drug effects / Q000502:physiology; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology / Q000517:prevention & control; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use
D043373:Follicle Stimulating Hormone, Human; D011994:Recombinant Proteins; D002996:Clomiphene