Luteal-phase clomiphene citrate in PCOS

Abstract

To the Editor: I read with interest the article by Badawy et al. (1Badawy A. Inany H. Mosbah A. Abulatta M. Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome: a novel protocol.Fertil Steril. 2009; 91: 538-541Abstract Full Text Full Text PDF Scopus (13) Google Scholar) on luteal phase clomiphene citrate (CC) treatment (1Badawy A. Inany H. Mosbah A. Abulatta M. Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome: a novel protocol.Fertil Steril. 2009; 91: 538-541Abstract Full Text Full Text PDF Scopus (13) Google Scholar). There were two points on which I would like to request clarification. In the early CC group, patients received 100 mg of CC daily, starting the day after finishing medroxyprogesterone acetate (MPA) before withdrawal bleeding. It is a well-known fact that patients with polycystic ovary syndrome (PCOS) have oligo-ovulation/anovulation. Occasional spontaneous ovulations and pregnancies do occur in these cases, and starting CC after finishing MPA may cause damage in those few cases of PCOS who may have conceived spontaneously. I would suggest that before starting CC on last day of MPA, pregnancy must be ruled out by estimation of serum β human chorionic gonadotropin (β-hCG) levels or by transvaginal sonography. If corpus luteum is seen, CC should not be started. Alternatively, instead of giving MPA for withdrawal and starting CC, one should wait for withdrawal bleeding to occur, and the patient should be put on oral contraceptive pills in the next cycle. Clomiphene citrate should be started after finishing oral contraceptive pills and before withdrawal bleeding, in the so-called luteal phase. The materials and methods section of the article states that withdrawal bleeding was achieved using 10-mg tablets of MPA for 10 days before stimulation. Patients were then randomly allocated using a computer-generated randomization table into two treatment groups: early CC and late CC. My concern is that if patients were randomly allocated after withdrawal, CC cannot be started in the early group, as the luteal phase is already over. Random allocation should have been done much earlier, before starting MPA. Reply of the Authors: Luteal-phase clomiphene citrate in PCOSFertility and SterilityVol. 92Issue 4PreviewI would like to thank Dr. Dhiraj Gada for his comments. Full-Text PDF Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome: a novel protocolFertility and SterilityVol. 91Issue 3PreviewTo test a novel protocol of luteal phase administration of clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS). Full-Text PDF