Treatment of Chronic Anovulation Resistant to Clomiphene Citrate (CC) by Using Gonadotrophin-Releasing Hormone Agonist (GnRH-A) Ovarian Suppression Followed by Recombinant Follicle-Stimulating Hormone (r-hFSH) Treatment (Suprecur, Puregon)

Abstract

We performed a prospective study to assess the effects of a starting dose of 50 units of recombinant follicle stimulating hormone (Puregon) during gonadotrophin-releasing hormone agonist therapy (Suprecur) on follicular development in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). In a prospective clinical trial, 25 women with clomiphene citrate-resistant PCOS who wanted to become pregnant were treated by a low-dose step-up protocol of SC recombinant follicle stimulating hormone administration during gonadotrophin-releasing hormone agonist therapy, monitored by transvaginal ultrasonography and retrospectively by serum endocrine assays taken at each monitoring visit. Cancellation of cycles, ovulation, rate and size of follicles growth, serum E<inf>2</inf> concentration and pregnancy were recorded. All patients exhibited a response: 22 patients ovulated, of whom 10 conceived. Using the low-dose protocol during gonadotrophin-releasing hormone agonist therapy permitted induction of ovulation safely and successfully in patients with clomiphene citrate-resistant PCOS who were patients previously difficult to treat with the conventional ovulation induction protocol.