Shahgheibi Sholeh, Seyedoshohadaei Fariba, Khezri Danial, Ghasemi Solmaz
Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Int J Reprod Biomed. 2021 Jul 27;19(6):537-544. doi: 10.18502/ijrm.v19i6.9375. eCollection 2021 Jun.
Various strategies have been proposed for polycystic ovary syndrome (PCOS) treatment.
To investigate and compare the number and size of ovarian follicles, endometrial thickness, and ovulation rate by traditional protocol (TP) and stair-step protocol (SSP).
Sixty infertile PCOS women were allocated into two groups (SSP = 30 and control TP = 30) between May and October 2019 in the Besat Hospital, Sanandaj, Iran. In the SSP group, the infertile women were treated with 50 mg/daily clomiphene citrate (CC) for five days, while the nonresponsive women were prescribed 100 mg daily CC for five days in the same cycle. The maximum dose (150 mg) was administered until ovulation occurred. In the control group, in non-ovulatory cases, the dose was increased in the next cycle. Ultrasound was used to detect ovulation.
Endometrial thickness changes with various doses of CC were significantly different in the TP. The comparison of both protocols showed a significant difference in endometrial thickness only at 50 mg CC. The number of follicles in the left ovary was significantly different in both protocols at 150-mg CC. The size of ovarian follicles in the left ovary was significantly different between the two protocols at 100-mg CC. The ovulation rate was significantly different in the SSP at 100- and 150-mg doses of CC. Moreover, 86% of ovulation occurred at 100-mg CC in the SSP, while this rate was 73% in the TP.
The most appropriate dose for ovulation in patients with PCOS is 100 mg CC.
针对多囊卵巢综合征（PCOS）的治疗已提出了多种策略。
通过传统方案（TP）和阶梯式方案（SSP）研究并比较卵巢卵泡的数量和大小、子宫内膜厚度及排卵率。
2019年5月至10月期间，在伊朗萨南达季的贝萨特医院，将60例不孕的PCOS女性分为两组（SSP组 = 30例，对照组TP = 30例）。在SSP组中，不孕女性每天服用50毫克枸橼酸氯米芬（CC），持续五天，而无反应的女性在同一周期内每天服用100毫克CC，持续五天。给予最大剂量（150毫克）直至排卵发生。在对照组中，对于无排卵的病例，在下一周期增加剂量。采用超声检测排卵情况。
TP组中，不同剂量CC下子宫内膜厚度变化存在显著差异。两种方案的比较显示，仅在50毫克CC时子宫内膜厚度存在显著差异。在150毫克CC时，两种方案中左卵巢卵泡数量存在显著差异。在100毫克CC时，两种方案中左卵巢卵泡大小存在显著差异。在100毫克和150毫克CC剂量下，SSP组的排卵率存在显著差异。此外，SSP组中86%的排卵发生在100毫克CC时，而TP组的这一比例为73%。
PCOS患者排卵的最合适剂量为100毫克CC。
