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Low-dose gonadotropin induction of ovulation in anovulatory women - still needed in the age of IVF
File(s)
Author(s)
White, Davinia
Hardy, Kate
Lovelock, Suzannah
Franks, Stephen
Type
Journal Article
Abstract
Low-dose, step-up gonadotropin is the treatment of choice for women with PCOS who have not conceived after anti-estrogen treatment, and as an effective alternative to pulsatile GnRH in women with hypogonadotropic hypogonadism (HH). There has been, however, no large-scale, comparative study between the two groups using low-dose gonadotropins. Here we performed a retrospective, comparative analysis, in a single clinic database, of efficacy and safety of induction of ovulation using low-dose gonadotropins in 364 Women with PCOS and 80 women with HH. The rate of ovulation was high in both PCOS (83%) and HH (84%) but mono-follicular, ovulatory cycles were more prevalent in PCOS than in HH (77% vs 53%, p<0.0001) and the proportion of cycles that were abandoned was higher in HH than in PCOS (25% vs 15%, p<0.0001). The median threshold dose of gonadotropin required to induce ovulation was 75iu/day in PCOS and 113iu/day in HH (p<0.001) and the range of doses was greater in HH women. Forty-nine percent of women with PCOS and 65% of those with HH conceived (more than 90% within 6 cycles of treatment) and had a least one pregnancy. Multiple pregnancies (all twins) occurred in only 4% of women with PCOS and 5% of those with HH. These findings emphasise the efficacy and safety of low-dose gonadotropin treatment for both clomiphene-resistant women with PCOS and those with HH. These results highlight the importance of choosing the more physiological approach of gonadotropin induction of ovulation in both groups as the most appropriate treatment, in preference to IVF.
Date Issued
2018-07-01
Date Acceptance
2018-02-19
Citation
Reproduction, 2018, 156, pp.F1-F10
URI
DOI
ISSN
1470-1626
Publisher
BioScientifica
Start Page
F1
End Page
F10
Journal / Book Title
Reproduction
Volume
156
Copyright Statement
© 2018 by the Society for Reproduction and Fertility.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29459401
PII: REP-17-0697
Subjects
1114 Paediatrics And Reproductive Medicine
0606 Physiology
1103 Clinical Sciences
Obstetrics & Reproductive Medicine
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-02-19