A comparative randomized multicentric study comparing the step-up versus step-down protocol in polycystic ovary...

Area of Science:

• Reproductive Endocrinology
• Infertility Treatments
• Ovarian Stimulation Protocols

Background:

• Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with infertility.
• Clomiphene citrate (CC) resistance is a frequent challenge in PCOS fertility management.
• Evaluating alternative stimulation protocols is crucial for improving outcomes in CC-resistant PCOS.

Purpose of the Study:

• To compare the efficacy of low-dose step-up versus step-down protocols for ovarian stimulation.
• To assess follicular development and ovulation rates in women with CC-resistant PCOS.
• To determine the optimal protocol for achieving monofollicular development and reducing hyperstimulation.

Main Methods:

• Randomized trial involving 83 women with CC-resistant PCOS.
• Treatment with recombinant follicle-stimulating hormone (rFSH) using either a step-up or step-down protocol.
• Follow-up for up to three cycles or until pregnancy occurred.

Main Results:

• The step-up protocol resulted in significantly higher rates of monofollicular development (68.2% vs. 32%) and ovulation (70.3% vs. 51.3%).
• Hyperstimulation was significantly less frequent with the step-up protocol (4.7% vs. 36%).
• No significant difference was observed in the total rFSH units used or cumulative clinical gestation rates between the protocols.

Conclusions:

• The step-up protocol is more efficient for achieving monofollicular development and ovulation in CC-resistant PCOS.
• While the step-up protocol involves a longer stimulation duration, it significantly reduces the risk of ovarian hyperstimulation.
• The step-up protocol offers a safer and more effective approach for ovarian stimulation in this patient population.