Increasing doses of clomiphene improve ovulation rate in PCOS.

Treatment consisting of gradually increasing doses of clomiphene followed by ultrasound is effective in reducing the time to ovulation and often improves the ovulation rate in women with polycystic ovarian syndrome (PCOS) who do not respond to lower doses of the drug, according to a study in the May issue of the American Journal of Obstetrics and Gynecology.

Bradley S. Hurst, MD, and colleagues from Carolinas Medical Center in Charlotte, NC, retrospectively analyzed whether a "stair-step" clomiphene protocol was effective in women with PCOS who did not respond to 50 mg of clomiphene. The protocol consisted of increases in clomiphene dose from 50 mg to 100 mg and 150 mg if the woman remained unresponsive, with each increase in dose followed by ultrasonography.

The researchers found that the stair-step protocol reduced the time to ovulation by 32 to 53 days compared with traditional clomiphene dosing. The ovulation rate was significantly higher for the stair-step protocol at a clomiphene dose of 100 mg compared with the expected rate for this dose with a traditional regimen (64% vs. 2%). However, the clinical pregnancy rate was similar for the two groups (13% vs. 15%).

Hurst BS, Hickman JM, Matthews ML, et al. Novel clomiphene “stair-step” protocol reduces time to ovulation in women with polycystic ovarian syndrome. Am J Obstet Gynecol. 200:510.e1-510.e4.