INCREASE IN ANDROGEN-ESTROGEN RATIO SPECIFICALLY DURING LOW-DOSE FOLLICLE-STIMULATING-HORMONE THERAPY FOR POLYCYSTIC-OVARY-SYNDROME

Objectives: To compare changes in serum androgens in women with polycy stic ovary syndrome (PCOS) during ovulation induction with low-dose ve rsus conventional urofollitropin. Design: Prospective case-control stu dy. Setting: Tertiary-care reproductive medicine center. Subjects: Thi rty-three women with PCOS who failed to conceive with clomiphene citra te therapy. Interventions: Urofollitropin (low-dose, 75 IU; convention al dose, 150 IU) was administered IM daily. Therapy was monitored by s erum E(2) and vaginal sonography. Hormone determinations were performe d by immunoassay. Main Outcome Measures: Serum E(2), androstenedione ( A), T, and LH levels. Results: On the day of hCG administration, patie nts treated with low-dose therapy exhibited significantly higher ratio s of A to E(2) (3.5 +/- 0.5 versus 2.2 +/- 0.3 [mean +/- SEM]) and T t o E(2) (1.5 +/- 0.3 versus 1.0 +/- 0.1) compared with conventional uro follitropin therapy. The number of follicles greater than or equal to 16 mm in diameter was significantly lower with low-dose therapy (2.7 /- 0.6 versus 5.4 +/- 0.4). Conclusions: Although low-dose therapy was associated with a reduction in the number of recruited follicles, the increase in androgen to E(2) associated with this therapy may adverse ly affect oocyte quality and may explain the relatively high miscarria ge rate reported in PCOS patients with this therapy.