title: Is clomiphene citrate stair-step protocol a good alternative to gonadotrophins in clomiphene-resistant PCO patients? Prospective study.
abstract: OBJECTIVE
  To compare the efficacy and safety of the clomiphene citrate (CC) stair-step protocol with standard gonadotrophin (follicle-stimulating hormone) treatment in clomiphene-resistant polycystic ovary syndrome (PCOS) patients. The study was a prospective cohort study in a tertiary infertility center in Abu Dhabi, United Arab Emirates (UAE).
  
  
  METHODS
  The subjects consisted of 100 PCOS CC-resistant patients who attended between January 2014 and January 2015. Fifty received CC again but in accordance with the stair-step protocol, and the other 50 received the standard gonadotrophin treatment used in the center in which the study was conducted. The primary outcome measure was dominant follicle achievement; the secondary outcome measures were (i) clinical pregnancy rate; (ii) time to ovulation measured from treatment initiation to sonographic confirmation of a dominant follicle in days; and (iii) adverse effect occurrence.
  
  
  RESULTS
  There was no difference between the two treatment modalities concerning the ability to achieve a dominant follicle or the clinical pregnancy rate. The time to ovulation was significantly shorter with the CC stair-step protocol than with gonadotrophin treatment. Ovarian hyperstimulation syndrome and ovarian cyst formation were more likely to occur with gonadotrophin treatment.
  
  
  CONCLUSIONS
  Clomiphene citrate stair-step protocol can be offered to PCOS CC-resistant patients as an alternative to gonadotrophin therapy with similar efficacy.
authors.affiliation: Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.|Hendawy Medical Center, Abu Dhabi, United Arab Emirates.
authors.forename: Amr M
authors.initials: AM
authors.lastname: Salaheldin AbdelHamid
authors.affiliation: Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Rateb
authors.affiliation: Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.|Dubai Fertility and Gynecology Center, Dubai, United Arab Emirates.
authors.forename: Wael A
authors.initials: WA
authors.lastname: Ismail Madkour
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000150:complications / Q000188:drug therapy*; D010060:Ovulation / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D005640:Follicle Stimulating Hormone
keywords: clomiphene citrate resistance; clomiphene citrate stair-step protocol; gonadotrophin; polycystic ovary syndrome