title: Novel clomiphene "stair-step" protocol reduces time to ovulation in women with polycystic ovarian syndrome.
abstract: OBJECTIVE
  The objective of the study was to determine the efficacy of a novel "stair-step" clomiphene protocol in women with polycystic ovarian syndrome (PCOS) who do not respond to 50 mg clomiphene.
  
  
  METHODS
  This was a retrospective analysis at an academic fertility center. The stair-step protocol is performed as follows: 50 mg clomiphene for 5 days, ultrasonography on days 11-14. If unresponsive, immediately begin 100 mg clomiphene for 5 days and repeat ultrasound in 1 week. If still unresponsive, begin 150 mg clomiphene for 5 days and repeat the ultrasound in 1 week. Stair-step cycles were compared with published historical clomiphene outcomes for women who were nonresponsive.
  
  
  RESULTS
  The time to ovulation was 32-53 days less with the stair-step protocol compared with a traditional regimen. The dose-dependent ovulation rate was 64% at 100 mg with the stair-step protocol compared with 22% with a traditional regimen.
  
  
  CONCLUSIONS
  It is not necessary to induce menses before increasing clomiphene doses in nonresponsive PCOS patients.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Hurst
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hickman
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Matthews
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Usadi
authors.forename: Paul B
authors.initials: PB
authors.lastname: Marshburn
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008598:Menstruation; D009839:Oligomenorrhea / Q000000981:diagnostic imaging / Q000188:drug therapy; D010060:Ovulation / Q000187:drug effects*; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene