Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome: a novel protocol.

OBJECTIVE

To test a novel protocol of luteal phase administration of clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS).

DESIGN

Prospective, randomized, controlled trial.

SETTING

University teaching hospital and private practice settings.

PATIENT(S): The study comprised a total of 212 women (438 cycles) with PCOS.

INTERVENTION(S): Patients in the early CC group received 100 mg of CC daily starting the next day after finishing medroxyprogesterone acetate (MPA) for 5 days (110 patients, 227 cycles), whereas the patients in the late CC group received 100 mg of CC daily for 5 days starting on day 3 of the menses (102 patients, 211 cycles).

MAIN OUTCOME MEASURE(S): Number of growing and mature follicles, serum E(2) (in picograms per milliliter), serum P (in nanograms per milliliter), endometrial thickness (in millimeters), occurrence of pregnancy and miscarriage.

RESULT(S): There were more ovulating patients in the early CC group (59.1% vs. 51.9%), without significant differences. The total number of follicles and the number of follicles >or=14 mm and >or=18 mm during stimulation were significantly greater in the early CC group. The endometrial thickness at the time of hCG administration was significantly greater in the early CC group (9.1 +/- 0.23 vs. 8.2 +/- 0.60 mm). Serum E(2) and P were not significantly different between the two groups. Pregnancy occurred in 23/110 cycles in the early CC group (20.9%) and 16/102 cycles (15.7%) in the late CC group; the difference was not statistically significant. The miscarriage rate was similar in the two groups.

CONCLUSION(S): Early administration of CC in patients with PCOS will lead to more follicular growth and endometrial thickness, which might result in a higher pregnancy rate (PR).