Treatment preferences and trade-offs for ovulation induction in clomiphene citrate-resistant patients with polycystic ovary syndrome.
OBJECTIVE
To investigate patient preferences and trade-offs for laparoscopic electrocautery of the ovaries relative to ovulation induction with recombinant FSH (rFSH) in patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS).


METHODS
Assessment of preferences and trade-offs in a randomized controlled trial.


METHODS
Academic hospital.


METHODS
Thirty-two CC-resistant patients with PCOS who had been randomly assigned to either laparoscopic electrocautery of the ovaries or ovulation induction with rFSH and 32 control patients with PCOS under treatment with CC.


METHODS
Preference for laparoscopic electrocautery relative to rFSH was established during an interview. Trade-offs between treatment burden and effectiveness were evaluated by varying hypothetical pregnancy rates after laparoscopic electrocautery until patients switched in their initial preference.


METHODS
Preference for laparoscopic electrocautery of the ovaries; trade-off between burden and effectiveness of treatment.


RESULTS
The majority of the patients would prefer electrocautery of the ovaries over ovulation induction with rFSH if both treatment strategies resulted in similar pregnancy rates. However, most patients were willing to trade off their preference for increased effectiveness: the percentage of patients who preferred electrocautery over rFSH sharply declined when the difference in hypothetical pregnancy rates was more than 5% in favor of rFSH.


CONCLUSIONS
Patients with polycystic ovary syndrome are well able to express an informed preference for laparoscopic electrocautery of the ovaries or ovulation induction with rFHS. Preferences are guided by features of the respective treatments but seem to be dominated by their effectiveness and safety.
Bayram
Neriman
N
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands. n.bayram@amc.uva.nl
van Wely
Madelon
M
van der Veen
Fulco
F
Bossuyt
Patrick M M
PM
Nieuwkerk
Pythia
P
D002996:Clomiphene / Q000627:therapeutic use*; D004564:Electrocoagulation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000523:psychology; D010062:Ovulation Induction / Q000379:methods* / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000523:psychology*; D017211:Treatment Failure; D016896:Treatment Outcome
D002996:Clomiphene