title: Clomiphene citrate before and after withdrawal bleeding for induction of ovulation in women with polycystic ovary syndrome: Randomized cross-over trial.
abstract: OBJECTIVE
  To compare the ovarian response to early versus late clomiphene citrate (CC) in women with polycystic ovary syndrome (PCOS).
  
  
  METHODS
  This cross-over randomized controlled clinical trial included 90 infertile amenorrheic women with PCOS. After inducing withdrawal bleeding, patients were randomly divided into two equal groups to receive ovulation induction with CC 100 mg/day for 5 days. Group I started treatment the next day after finishing medroxyprogesterone acetate course for a menstrual cycle, and after a washout period of another menstrual cycle, the treatment was shifted to start on day 2 of withdrawal bleeding. Group II received a reversed protocol: late then early treatment. Women were followed up on transvaginal ultrasonography to monitor follicular growth, endometrial thickness and evidence of ovulation. Human chorionic gonadotropin 10 000 IU was given i.m. to trigger ovulation when at least one mature follicle measured ≥18 mm at day 14.
  
  
  RESULTS
  In all cases, early induction protocol resulted in significantly higher proportion of ovulating patients, thicker endometrium and higher number of follicles 14-17 mm in diameter, ≥ 18 mm in diameter and total number of follicles (P < 0.001 for all comparisons).
  
  
  CONCLUSIONS
  In women with PCOS, early initiation of CC before withdrawal bleeding or during the last days of the luteal phase can achieve a better ovulatory response.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt.
authors.forename: Ahmed E H
authors.initials: AE
authors.lastname: Elbohoty
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amer
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, AinShams University, Abbasia, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelmoaz
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D000858:Anovulation / Q000188:drug therapy*; D002996:Clomiphene / Q000627:therapeutic use*; D004965:Estrogen Antagonists / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000150:complications / Q000188:drug therapy*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*
chemical_list: D004965:Estrogen Antagonists; D005300:Fertility Agents, Female; D002996:Clomiphene
keywords: ClinicalTrials.gov Identifier: NCT02024984; amenorrhea; anovulation; clomiphene citrate; induction of ovulation; polycystic ovary syndrome