Octreotide is not useful for clomiphene citrate resistance in patients with polycystic ovary syndrome but may reduce the likelihood of ovarian hyperstimulation syndrome

Objective: To determine whether octreotide is effective for ovulation induc tion in patients with polycystic ovary syndrome (PCOS) and clomiphene citra te resistance or for reduction of the risk of ovarian hyperstimulation synd rome (OHSS) with gonadotropin therapy. Design: Prospective. double-blind, placebo-controlled, crossover trial. Setting: Private infertility practice. Patient(s): Twelve patients with PCOS undergoing therapy for infertility. Intervention(s): The patients: were assigned randomly to receive either oct reotide or placebo. Those with clomiphene citrate-resistant PCOS received c lomiphene citrate, 150 mg. Patients at risk for the development of OHSS rec eived urinary FSH for ovulation induction. Main Outcome Measure(s): Ovulation, pregnancy, the development of OHSS, and levels of fasting insulin, insulin-like growth factor 1, insulin-like grow th factor binding proteins 1 and 3, testosterone, androstenedione, DHEAS, E -2, LH, and FSH. Result(s): Octreotide significantly reduced levels of fasting insulin. insu lin-like growth factor 1, and LH in both clomiphene citrate- and urinary FS H-stimulated cycles. Levels of insulin-like growth factor binding protein 3 were increased. Two of six clomiphene citrate-stimulated cycles reached ov ulation with the use of either octreotide or placebo. In urinary FSH-stimul ated cycles, patients who received octreotide had significantly lower E-2 l evels at the time of hCG administration and fewer mature follicles. No case s of OHSS occurred in either group. One pregnancy occurred in each group. Conclusion(s): Octreotide was no more effective than placebo for clomiphene citrate resistance in patients with PCOS, but it did reduce E-2 levels and follicle numbers when combined with urinary FSH. Thus, octreotide may redu ce the incidence of OHSS in patients with PCOS. (Fertil Steril(R) 1999;71:4 52-6. (C)1999 by American Society for Reproductive Medicine.).