Abstract
Objective To evaluate effectiveness and safety of a regimen of extended clomiphene citrate (CC) and prednisone for patients who fail treatment with CC alone.
Design Retrospective observational analysis.
Setting University-based tertiary infertility center.
PATIENT(S): Twenty-four anovulatory patients who failed to ovulate after CC 150 mg administered for 5 days.
INTERVENTION(S): Treatment consisted of CC given on cycle days 3 through 9 (extended) at a starting dose of 100 to 150 mg/d. Additionally, patients were given prednisone 5 mg orally each night throughout the cycle.
MAIN OUTCOME MEASURE(S): Ovulation was confirmed by luteal serum P. Pregnancy was confirmed by rising hCG levels and transvaginal ultrasound.
RESULT(S): A total of 60 cycles were available for review. Forty-four of these cycles were ovulatory (73%) and 11 patients (46%) conceived on this therapy. Logistic (two-parameter) pregnancy occurrence over time (cycles) revealed a maximum pregnancy probability of 0.66 and a cycle fecundity of 0.36. No complications of therapy were noted.
CONCLUSION(S): Clomiphene citrate-resistant anovulatory patients have high rates of ovulation and pregnancy after treatment with extended CC and prednisone. This therapy offers a potential reduction in cost and risk and should be considered in this group of patients before gonadotropin stimulation or surgery.
clomiphene citrate resistance extended dosing prednisone, CC-resistant anovulation corticosteroid treatment, extended clomiphene citrate chronic anovulation, clomiphene resistant patients pregnancy rates, prednisone clomiphene ovulation induction, anovulation ovulation failure clomiphene alternatives, clomiphene citrate extended protocol dosing, anovulatory infertility medical management, corticosteroid adjunct ovulation induction therapy, clomiphene unresponsive patients treatment outcomes
PMID 9093187 9093187 DOI 10.1016/s0015-0282(97)81359-3 10.1016/s0015-0282(97)81359-3
Keywords
Adult, Anovulation/drug Therapy, Chronic Disease, Clomiphene/administration & Dosage/pharmacology/therapeutic Use, Drug Resistance, Drug Therapy, Combination, Female, Fertility Agents, Female/administration & Dosage/pharmacology/therapeutic Use, Glucocorticoids/administration & Dosage/pharmacology/therapeutic Use, Humans, Logistic Models, Male, Ovulation/drug Effects/physiology, Prednisone/administration & Dosage/pharmacology/therapeutic Use, Retrospective Studies, Treatment Outcome, Fertility Agents, Female, Glucocorticoids, Clomiphene, Prednisone