title: Ovulation rate and cycle characteristics in a subsequent clomiphene citrate cycle after stair-step protocol.
abstract: OBJECTIVE
  To determine the ovulation rate after ovulation induction with clomiphene citrate (CC) in women who had previously been ovulatory after a stair-step (CC-SS) ovulation induction.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  University-based tertiary fertility center.
  
  
  METHODS
  61 anovulatory patients <40 years of age with polycystic ovary syndrome who underwent ovulation induction with a CC-SS protocol and a subsequent CC cycle.
  
  
  METHODS
  Ovulation induction with CC.
  
  
  METHODS
  Ovulation rates and cycle characteristics.
  
  
  RESULTS
  Of 61 patients who underwent a subsequent CC cycle, 15 (25%) failed to ovulate at the previously ovulatory dose. Of those 15 patients, 13 (86.7%) ovulated after an increase in dose. The total number of follicles ≥15 mm (2.8 ± 1.2 vs. 1.6 ± 0.7) and peak estradiol (E2) levels (604 ± 272 pg/mL vs. 447 ± 218 pg/mL) were statistically significantly higher in the CC-SS cycle compared with the subsequent CC cycle, respectively. The endometrial lining was statistically significantly thinner in the CC-SS than the CC cycle (7.8 ± 1.8 vs. 9.2 ± 2.7, respectively).
  
  
  CONCLUSIONS
  The majority of patients who ovulate after a CC-SS protocol will ovulate after taking the previously ovulatory CC dose in a subsequent cycle. Those who do not ovulate will likely ovulate with a further increase in CC dose.
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Tara H
authors.initials: TH
authors.lastname: Budinetz
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Benadiva
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Griffin
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Engmann
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: John C
authors.initials: JC
authors.lastname: Nulsen
authors.affiliation: Center for Advanced Reproductive Services, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut. Electronic address: diluigi@uchc.edu.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: DiLuigi
mesh_terms: D000328:Adult; D000858:Anovulation / Q000188:drug therapy / Q000453:epidemiology; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000453:epidemiology; D008597:Menstrual Cycle / Q000187:drug effects* / Q000502:physiology; D010060:Ovulation / Q000187:drug effects* / Q000502:physiology; D010062:Ovulation Induction / Q000379:methods* / Q000706:statistics & numerical data; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene
keywords: Anovulation; clomiphene citrate; ovulation induction; polycystic ovary syndrome; stair-step protocol