A comparative study of fixed-dose, step-down, and low-dose step-up regimens of human menopausal gonadotropin for patients with polycystic ovary syndrome

Abstract

Objective: To compare the efficacy and safety of the fixed-dose, the step-down, and the low-dose step-up regimens of hMG for women with polycystic ovary syndrome (PCOS). Design: Prospective randomized study. Setting: Gunma University School of Medicine, Maebashi, Japan. Patient(s): Thirty-seven women with PCOS. Intervention(s): The fixed-dose, the step-down, and the low-dose step-up regimens were administered. Main Outcome Measure(s): The number of growing follicles and serum hormone levels. Result(s): Serum FSH levels on the day of hCG administration were significantly higher in the fixed-dose regimen group than in the step-down and the low-dose step-up regimen groups, and the number of growing follicles (≥11 mm) in the low-dose step-up regimen group was significantly smaller than in the fixed-dose regimen group. On the 7th day after hCG administration, the maximal diameter of the ovaries in the low-dose step-up regimen group was significantly smaller than in the fixed-dose and the step-down regimen groups, and the risk of excessive ovarian enlargement (≥70 mm) was significantly lower in the low-dose step-up regimen group than in the fixed-dose regimen group. Conclusion: The low-dose step-up regimen of hMG for patients with PCOS may be the safest protocol among the three stimulation regimens for reducing multiple follicular development.