GONADOTROPINS STEP-DOWN PROTOCOL FOR OVULATION INDUCTION IN POLYCYSTIC OVARIAN DISEASE

Abstract

These 40 PCOS infertile patients included in our study were divided into two groups, each group consisted of 20 patients who were subjected to full history taking, thorough clinical examination and specific investigations. These investigations included hormonal assay, ultrasonography and or laparoscopy. PCOS was the factor responsible for the infertility. The two groups were matched regarding their means of ages, period of infertility and BMI.

Group I patients were given the Conventional step Up protocol. We started by an initial dose of two ampoules ofFSH given IM for 5 days from the third day of a spontaneous or progesterone induced menstrual cycle. The dose was increased by one ampoule every 3-5 days until there is evidence of active follicular development. The latter is based on the result of vaginal ultrasonographic and hormonal monitoring (rapid plasma Estradiol E2 assay) performed every one or two days. When the leading follicle reached at least 18 mm and E2 level exceeded 200 pg/ml we gave 1000 IU ofHCG

Group II patients were allocated to the Low dose step down protocol. We started by an initial dose of two ampoules ofFSH given IM for 4 days from the third day of a spontaneous or progesterone induced menstrual cycle. This dose was maintained dose until there is evidence of active follicular development with one follicle equal to or more than 10 mm,