SEQUENTIAL STEP-UP AND STEP-DOWN DOSE REGIMEN - AN ALTERNATIVE METHODFOR OVULATION INDUCTION WITH FOLLICLE-STIMULATING-HORMONE IN POLYCYSTIC OVARIAN SYNDROME

This study was designed to compare both the effectiveness and safety o f two low-dose gonadotrophin regimens (step-up versus sequential step- up and step-down) for ovulation induction in polycystic ovarian syndro me (PCOS) patients. In all, 56 infertile clomiphene citrate-resistant PCOS patients were included in this prospective randomized study. A to tal of 38 cycles were conducted with a classic step-up protocol, where as for 35 cycles the follicle-stimulating hormone (FSH) threshold dose was reduced by half when the leading follicle reached 14 mm in diamet er (sequential protocol). Serum oestradiol, progesterone and luteinizi ng hormone concentrations and follicular growth rate were evaluated du ring the cycle. At the time of human chorionic gonadotrophin administr ation, cycles treated with sequential protocol exhibited significantly lower oestradiol concentrations [434 +/- 45 versus 593 +/- 67 pg/ml ( mean +/- SEM)] and the number of medium-sized (14-15 mm) follicles was significantly reduced (0.3 +/- 0.1 versus 0.8 +/- 0.2) compared with cycles treated with the classic step-up protocol, Moreover, in these c ycles serum luteal oestradiol concentrations were decreased significan tly (350 +/- 77 versus 657 +/- 104 pg/ml) compared with the classic st ep-up protocol. A sequential step-up and step-down protocol seems to b e a safe and effective regimen for ovulation induction in PCOS patient s. Decreasing the FSH dose following step-up follicular selection may be an alternative method to avoid multifollicular development.