BACKGROUND: To evaluate the efficacy of Clomiphene Citrate (CC) with low dose Human menopausal gonadotrophin (hMG) in CC resistant infertile women with Polycystic Ovarian Syndrome (PCOS).
DESIGN: Prospective single arm interventional study.
SETTING: Infertility clinic attached to Women Child Hospital, JIPMER, India.
PATIENTS AND METHODS: Infertile women diagnosed with PCOS who are Clomiphene Citrate resistance. We excluded women who underwent Laparoscopic Ovarian Drilling (LOD) within 6months or who had other factors of infertility.
INTERVENTION: Ninety-one CC resistant PCOS women were recruited. CC (100 mg/day for 5 days) followed by Human Menopausal Gonadotrophin (hMG) (75IU IM for 3 days) were administered. Three Additional doses of hMG were given if dominant follicular size was not achieved. Intrauterine Insemination (IUI) was not done. If pregnancy was not achieved, course was repeated for 3 cycles.
MAIN OUTCOME MEASURE: Ovulation rate and cumulative pregnancy rate. RESULTS: Ovulation rate was 92.3% and cumulative pregnancy rate observed was 20.9% with sequential clomiphene citrate and low dose hMG among CC resistant PCOS. Thirty three percent of study population ovulated with three doses of hMG whereas 59.3% of cases required additional hMG doses. All patients who underwent LOD ovulated and 37% achieved pregnancy, but lacked clinical significance due to small sample size. We observed four cases of ovarian cysts and only one case each of OHSS and multiple pregnancy.
CONCLUSION: Sequential clomiphene citrate and low dose hMG regimen is a good option for clomiphene citrate resistant PCOS women with a 20% chance of pregnancy over 3 cycles and decreased risk of side effects.
