Is clomiphene citrate stair‐step protocol a good alternative to gonadotrophins in clomiphene‐resistant PCO patients? Prospective study

Abdelhamid, Amr M.; Rateb, Ahmed; Madkour, Wael A. Ismail

doi:10.1111/jog.12940

Cited by 7 publications

(7 citation statements)

References 41 publications

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“…The stair‐step protocol provides a cumulative effect of successive OI cycles on the same follicle, or a single follicle step‐up effect like we already used during gonadotropin OI cycles. This cumulative effect may contribute positively to the treatment of CC‐resistant patients 25 . Considering that LTZ increases follicles' sensitivity to FSH, it shows that ovulation can be achieved even with low dose LTZ in CC‐resistant patients.…”

Section: Discussionmentioning

confidence: 96%

Comparison of the efficacy of letrozole stair‐step protocol with clomiphene citrate stair‐step protocol in the management of clomiphene citrate‐resistant polycystic ovary syndrome patients

Şakar

Oğlak

2021

J of Obstet and Gynaecol

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Purpose We sought to compare the efficacy of the letrozole (LTZ) stair‐step protocol with clomiphene citrate (CC) stair‐step protocol in the management of 150 mg dose of CC‐resistant polycystic ovary syndrome (PCOS) patients. Methods We retrospectively compared a total of 61 patients diagnosed as being resistant to the traditional CC protocol who were subsequently managed using the LTZ stair‐step protocol with CC‐resistant 56 patients who were treated with CC stair‐step protocol. The number of follicles ≥18 mm, endometrial thickness, time to ovulation, clinical pregnancy rates, multiple pregnancy rates, spontaneous abortion rates, live birth rates, and systemic side effects in patients were evaluated. Results The mean time to ovulation was significantly shorter in the LTZ stair‐step group than the CC stair‐step group (17.3 ± 7.7 and 22.4 ± 8.1 days, respectively, p < 0.001). The ovulation rate was significantly higher in patients treated with LTZ stair‐step protocol than those treated with the CC stair‐step protocol (83.6% and 64.2%, respectively, p = 0.007). The clinical pregnancy rate was higher in the LTZ stair‐step than the CC stair‐step group (32.7% and 17.8%, respectively, p = 0.015). LTZ stair‐step group had a significantly higher live birth rate than that of the CC stair‐step group (27.8% and 14.2%, respectively, p = 0.012). Conclusion The LTZ stair‐step protocol revealed higher ovulation, clinical pregnancy, and live birth rates with a shorter time to achieve ovulation than the CC stair‐step protocol. Increment of the dose in the same cycle in both protocols did not cause any additional severe side effects.

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Section: Discussionmentioning

confidence: 96%

Comparison of the efficacy of letrozole stair‐step protocol with clomiphene citrate stair‐step protocol in the management of clomiphene citrate‐resistant polycystic ovary syndrome patients

Şakar

Oğlak

2021

J of Obstet and Gynaecol

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“…Clomiphene citrate (CC) is still holding its place for ovulation induction being simple, safe, cheap and effective [3] [4]. However, clomiphene-resistance, i.e., failure to ovulate after receiving 150 mg/day for at least three cycles for five days per cycle affects 15% -40% of patients with PCOS [5]. Factors involved in CC resistance include increased body mass index, Insulin resistance, and hyperandrogenemia; Also, a hereditary predisposition plays a role [6].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Letrozole and Clomiphene Citrate versus Letrozole Alone in Clomiphene Citrate Resistant Polycystic Ovary Syndrome: A Randomised Controlled Trial

Ibrahem¹

2019

OJOG

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Background: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. The therapeutic strategies for clomiphene citrate (CC)resistant patients include the addition of corticosteroids, extended duration of clomiphene, gonadotrophin therapy, laparoscopic ovarian drilling, in vitro fertilization or the use of aromatase inhibitors recently. Letrozole decreases estrogen levels in the body, so it releases the hypothalamus and/or pituitary gland from the negative feedback of estrogen. This increases levels of gonadotrophins, which stimulates follicular growth. Objectives: To evaluate the role of letrozole alone and simultaneous use of letrozole and clomiphene citrate (CC) for ovulation induction in patients with clomiphene citrate-resistant PCOS (CCR-PCOS). Patients and Methods: This open-label randomised controlled study was conducted in the Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt during the period from February 2018 to June 2019. The study included 60 CCR-PCOS patients who were randomly allocated by independent personnel into two arms: group A (letrozole alone) or B (letrozole + CC). In either group, monitoring the mean follicular diameter and endometrial thickness in the days 10, 12, and 14 of the cycle by transvaginal ultrasound and Measurement of serum Progesterone (ng/ml) 7 days after the expected time of ovulation. Results: We investigated various clinical and sonographic factors that may predict the outcome of the method of induction of ovulation in CCR-PCOS with no significant affection for the results. There was a non-significant difference between the studied groups regarding ovulation and pregnancy per cycle or per patient. Conclusion: Letrozole alone or simultaneous use of letrozole and CC offers a good second-line option for induction of ovulation in CCR-PCOS patients. How to cite this paper: Ibrahem, M.A.

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“…However, this regimen could result in long‐term daily injections of FSH, up to 28‐35 days in each cycle, which increases the economic, mental, and physical burden of patients with PCOS. Therefore, a therapy other than gonadotropin therapy is needed for CC‐resistant patients and some modified CC treatment protocols have been developed …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, a therapy other than gonadotropin therapy is needed for CC-resistant patients and some modified CC treatment protocols have been developed. 9,10 In patients with PCOS who are receiving low-dose FSH treatment, it is difficult to predict when the follicles will respond to FSH and when follicular growth will start. As a result, the long-term administration of FSH is needed.…”

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confidence: 99%

Usefulness of intermittent clomiphene citrate treatment for women with polycystic ovarian syndrome that is resistant to standard clomiphene citrate treatment

Takasaki

Tamura

Okada‐Hayashi

et al. 2018

Reprod Medicine & Biology

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PurposeClomiphene citrate (CC) has been used as a first‐line treatment for anovulatory polycystic ovary syndrome (PCOS). However, some patients with PCOS are resistant to standard CC treatment. In this study, a new CC treatment protocol was developed, named “intermittent CC treatment” (ICT) and its efficacy was investigated on the induction of follicular growth in patients with PCOS who were resistant to standard CC treatment.MethodsOf the 42 patients with PCOS who were resistant to standard CC treatment (50 mg/day, 5 days), 26 underwent ICT. They were given 100 mg/day of CC for 5 days from the next menstrual cycle day (MCD) 5 (first CC). If follicular growth was not observed on MCD 14, they were given 100 mg/day of CC for 5 days (MCD 14‐MCD 18) (second CC). If follicular growth still was not observed on MCD 23, they were treated with CC again in the same way (third CC).ResultsThe first CC, second CC, and third CC were effective for 3/26 (11.5%) patients, 12/23 (52.2%) patients, and 6/11 (54.5%) patients, respectively. In total, ICT was effective for 21/26 (80.8%) patients with CC‐resistant PCOS.ConclusionThus, ICT is a useful treatment and could be an alternative to gonadotropin therapy for patients with CC‐resistant PCOS.

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Is clomiphene citrate stair‐step protocol a good alternative to gonadotrophins in clomiphene‐resistant PCO patients? Prospective study

Abstract: Clomiphene citrate stair-step protocol can be offered to PCOS CC-resistant patients as an alternative to gonadotrophin therapy with similar efficacy.

Cited by 7 publications

References 41 publications

Comparison of the efficacy of letrozole stair‐step protocol with clomiphene citrate stair‐step protocol in the management of clomiphene citrate‐resistant polycystic ovary syndrome patients

Comparison of the efficacy of letrozole stair‐step protocol with clomiphene citrate stair‐step protocol in the management of clomiphene citrate‐resistant polycystic ovary syndrome patients

Simultaneous Letrozole and Clomiphene Citrate versus Letrozole Alone in Clomiphene Citrate Resistant Polycystic Ovary Syndrome: A Randomised Controlled Trial

Usefulness of intermittent clomiphene citrate treatment for women with polycystic ovarian syndrome that is resistant to standard clomiphene citrate treatment

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