Comparative Study between Stair-step Protocol of Clomiphene Citrate and Combined Clomiphene and Gonadotropins for Induction of Ovulation in Women with Polycystic Ovary Syndrome

Background: Polycystic ovary syndrome affects 7 to 8% of women and may be the most common cause of female infertility. Anovulation, early pregnancy loss has all been implicated in the low fecundity. The aim of this study was to compare between the use of clomiphene citrate by stair-step protocol and use of combined clomiphene citrate and gonadotropins in patients with polycystic ovary syndrome.

Methods: This randomized non blinded controlled clinical study was carried out on 60 Patients who was selected from outpatient clinic of Tanta university hospitals from September 2019 to September 2020. Selected patients were allocated into two groups with 1:1 ratio. Group (A): was subjected to clomiphene citrate stair-step stimulation protocol. Group (B): was subjected to combined clomiphene and gonadotropins stimulation protocol.

Results: Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Age, BMI and duration of infertility). Significance defined by p < 0.05. Chi-square analysis was used for the categorical variable (number of MGF). Mann-Whitney U test was used to compare quantitative data because it is not normally distributed (Size of larger follicle and Endometrial thickness), Chi-square analysis was used for the categorical variables (Ovulation rate and Pregnancy rate). Mann-Whitney U test was used to compare quantitative data which are not normally distributed (FSH and LH). Student t test was used for the quantitative data which are normally distributed (Prolactin and TSH).

Conclusions: In conclusion, the CC stair‐step protocol is a safe, simple option for the management of PCOS patients, having a larger number of mature Grafian follicle, lower endometrial thickness and higher ovulation rate compared to combined clomophine and gonadotrophin protocol.