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KMID : 0377519930180010095
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Chung-Ang Journal of Medicine
1993 Volume.18 No. 1 p.95 ~ p.104
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Treatment of Clomiphene Citrate-resistant Polycystic Ovarian Disease With Low-dose Purified Follicle-stimulating Hormone and Gonadotropin -releasing Hormone Agonist
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Abstract
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Clomiphene Citrate(CC0 is particularly useful in women who have anovulation assiciated with polycystic ovaries. Successful ovulation treated by CC occurs in 75-85% of women with polycystic ovarian disease (PCOD), and the remaining 15-25% with
failure of
ovulation are secondarily treated with exogenous gonadortropin treatment in PCOD has three major complications of ovarian hyperstimulation (OHSS), multiple pregnancy, and relatively low fecundity. But recently the use of pure follicle-stimulating
hormone(PFSH) has been proposed to treat PCOD to avoid major complications occurred by human menopausal gonadotropinc(hMG) treatment. Also gonadotropin-releasing hormone agonist(GnRH-a) for maturation of the final stage of the follicles and
triggering
ovulation was appeared to induce midcycle LH surge similar to natural cycle.
We undertook a randomized study from November 1991 to march 1992, and the purpose of this study was to evaluate the effectiveness of the low-dose FSH/GnRH-a treatment in women with CC-resistant or OHSS-experienced PCOD. This regimen started with
75IU
pFSH daily from MCD#2 to 7 and then increasing by 37.5IU/d until there was evidence of active follicular development (1 follicle≥18.0mm or 2 follicles≥14.0mm). GnRH-a was injected subcutaneously 0.1mg twice with interval of 12 hours after the
last
pFSH injection.
@ES The results were as follows:
@EN 1. The number of leading follicles was 2.9±1.3.
2. No OHSS was occurred.
3. Midcycle serum LH and FSH surge similar to the natural cycle were observed.
4. The rate of pregnancy was 46%(6/13 cycles).
5. The concentrations of serum LH on GnRH-a day were significantly decreased than on MCD#2(P<0.05).
We suggest that the low-dose pFSH/GnRH-a treatment is effective in the prevention of OHSS and the reduction of the number of leading follicles in women with CC-resistant or OHSS-complicated PCOD.
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KEYWORD
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