Management of women with polycystic ovary syndrome who experienced premature luteinization during clomiphene citrate treatment

Abstract

Objective: To determine the preferred treatment modality in patients with PCOS who experienced premature luteinization during CC treatment. Design: Prospective randomized study. Setting: Tertiary medical center. Patients: Twenty-two infertile women with PCOS demonstrating premature luteinization during at least two consecutive CC cycles. Interventions: Randomized induction of ovulation either with FSH alone or with GnRH agonist combined with FSH for a single treatment cycle. Main Outcome Measures: Premature luteinization was defined as serum progesterone >1.5 ng/mL before hCG administration. Results: Premature luteinization occurred in eight of the 10 patients (80%) in group A and in two of the 12 patients in group B (16.6%). This result corresponds to the higher mean (±SD) progesterone level present in group A patients as compared to those in group B (2.0 ± 1.2 ng/mL vs. 1.2 ± 0.6 ng/mL, P=0.03). No pregnancies were achieved in group A, whereas the pregnancy rate per cycle observed in group B was 33.3% (4/12). On the day of hCG administration, the maximum mean (±SD) estradiol level was significantly lower ( P<0.0001) in group A (210.6 ± 37.9 pg/mL) than in group B (600.3 ± 253.8 pg/mL). The treatment duration and the number of FSH ampules used did not differ between the groups. Conclusions: Pituitary desensitization with GnRH analog in combination with FSH is superior to FSH-only treatment in PCOS patients who demonstrate premature luteinization during CC treatment.