Low-Dose Gonadotropins plus Intrauterine Insemination Treatment in Patients with Clomiphene Resistant Polycystic Ovary Syndrome

R Pabuçcu,N.K Duru,E Orhon,T Küçük,M.C Yenen

doi:10.1016/s0015-0282(00)01131-6

R Pabuçcu, N.K Duru + Show 3 more

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https://doi.org/10.1016/s0015-0282(00)01131-6

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Journal: Fertility and Sterility	Publication Date: Sep 1, 2000
License type: publisher-specific-oa

Affiliation: Gülhane Askerî Tıp Akademisi

Abstract

Objectives: Ovulation induction (OI) with gonadotropins is widely accepted as the second-line treatment in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). Low-dose step-up regimen was suggested to have comparable pregnancy rates (PR) with minimal risk of multiple pregnancy and ovarian hyperstimulation syndrome. This study was designed to determine the effect of intrauterine insemination (IUI) added to low-dose gonadotropins in patients with CC-resistant PCOS. Design: A randomized controlled clinical trial. Materials and Methods: Twenty-eight patients with PCOS who previously failed to conceive despite 3 ovulatory cycles of CC were randomized to 3 groups; (i) OI with CC (100 mg/d) and IUI (n:8), (ii) OI with low dose gonadotopins and IUI (n. 10), (iii) OI with low dose gonadotropins (n:10). Fifteen patients with PCOS who previously failed to develop preovulatory follicles in 3 cycles on CC (100–200 mg/d) were randomized to 2 groups; (i) OI with low dose gonadotropins (n:7), (ii) OI with low dose gonadotropins and IUI (n:8). In IUI cycles, two IUI procedures were done and sperm was prepared using a two-step wash procedure. Results: In patients with failure to conceive despite ovulation on CC, ongoing PRs per started cycles were 4/8 (50%) In CC+IUI group, 6/10 (60%) in low dose gonadotropin+IUI group, and 2/10 (20%) in low dose gonadotropin only group (p<0.05). In patients with failure to develop follicles on CC, ongoing PRs per started cycles were 2/19 (10%) in low dose gonadotropin only group, and 4/19 (21%) in low dose gonadotropin+IUI group (p>0.05). Conclusions: In case of anovulatory resistance to CC, we offer combination of low dose gonadotropin regimen with IUI in order to decrease the number of cycles with costly gonadotropins to achieve a pregnancy. In case of non-conceptional resistance either to CC or gonadotropins, IUI should be tried before stepping up to a higher line of treatment.

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