Recombinant human follicle-stimulating hormone for ovulation induction in polycystic ovary syndrome: A prospective, randomized trial of two starting doses in a chronic low-dose step-up protocol

Purpose: The aim was to compare the follicular response to 37.5 and 50 IU o f recombinant follicle-simulating hormone (FSH) as starting doses for ovula tion induction in patients with polycystic ovary syndrome (PCOS). Methods: Prospective, randomized crossover study including 15 women with cl omiphene citrate-resistant chronic anovulatory infertility. Patients were t reated with subcutaneous recombinant FSH at starting doses of 37.5 IU and 5 0 IU, respectively according to a low-dose step-up protocol. Each woman rec eived both treatments, in a randomized or der, with an interval of greater than or equal to1 month between treatments. Results: All treatment cycles were ovulatory after an appropriate follicula r response and hormone levels were similar with both treatments, althorlgh the total quantity of FSH required and the mean daily dose required to indu ce identical follicular development were significantly lower with a startin g dose of 37.5 IU FSH. The mean duration of treatment to achieve ovulation was approximately 13 days with both treatments but treatment periods greate r than or equal to 20 days were required in some patients. Conclusions: In women with PCOS, a starting dose of 37.5 IU recombinant FSH may be adequate to induce follicular growth. However; the rise of low stal ring doses mcay result in some cases in increased treatment periods and ne ed for monitoring.