Human Reproduction, Vol. 18, No. 11, 2357-2362,
November 2003
© 2003 European Society of Human Reproduction and Embryology
High singleton live birth rate following classical ovulation induction in normogonadotrophic anovulatory infertility (WHO 2)
1 Center for Clinical Decision Sciences, Department of Public Health and 2 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC- University Medical Center Rotterdam, The Netherlands
3 To whom correspondence should be addressed at: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. e-mail: b.c.j.m.fauser{at}erasmusmc.nl
BACKGROUND: Medical induction of ovulation using clomiphene citrate (CC) as first line and exogenous gonadotrophins as second line forms the classical treatment algorithm in normogonadotrophic anovulatory infertility. Because the chances of success following classical ovulation induction are not well established, a shift in first-line therapy can be observed towards alternative treatment. The study aim was to: (i) reliably assess the probability of singleton live birth following classical induction of ovulation; and (ii) construct a prediction model, based on individual patient characteristics assessed upon standardized initial screening, to help identify patients with poor chances of success. METHODS: A total of 240 consecutive women visiting a specialist academic fertility unit with a history of infertility, oligomenorrhoea or amenorrhoea, and normal FSH and estradiol serum concentrations (WHO group 2) was prospectively followed. The women had not been previously treated with ovulation-inducing agents. All patients commenced with CC. Patients who did not ovulate within three treatment cycles of incremental daily doses up to 150 mg for 5 consecutive days or ovulatory CC patients who did not conceive within six cycles, subsequently underwent gonadotrophin induction of ovulation applying a step-down dose regimen. The main outcome measure was pregnancy resulting in singleton live birth. Cox regression was used to construct a multivariable prediction model. RESULTS: Overall, there were 134 pregnancies ending in a singleton live birth (56% of women). The cumulative pregnancy rate after 12 and 24 months of follow-up was 50% and 71% respectively. Polycystic ovary syndrome (PCOS) patients (49%), clearly non-PCOS patients (13%) and the in-between group did not differ in prognosis (P = 0.9). The multivariable Cox regression model contained the woman’s age, the insulin:glucose ratio and duration of infertility. With a cut-off value of 30% for low chance, the model predicted probabilities at 12 months lower than this cut-off for 25 out of 240 patients (10.4%). CONCLUSIONS: Classical ovulation induction produces very good results in normogonadotrophic anovulatory infertility. Alternative treatment options may not be indicated as first-line therapy in these patients, except for subgroups with poor prognosis. These women can be identified by older age, longer duration of infertility and higher insulin:glucose ratio.
Key words: anovulation/clomiphene citrate/hMG/pregnancy rate/prognosis
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consens Consensus on infertility treatment related to polycystic ovary syndrome Hum. Reprod., March 1, 2008; 23(3): 462 - 477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B.C.J.M. Fauser, K. Diedrich, P. Devroey, and on behalf of the Evian Annual Reproduction (EVAR) Predictors of ovarian response: progress towards individualized treatment in ovulation induction and ovarian stimulation Hum. Reprod. Update, January 1, 2008; 14(1): 1 - 14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C.M. Boomsma, M.J.C. Eijkemans, E.G. Hughes, G.H.A. Visser, B.C.J.M. Fauser, and N.S. Macklon A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome Hum. Reprod. Update, November 1, 2006; 12(6): 673 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Moll, P. M M Bossuyt, J. C Korevaar, C. B Lambalk, and F. van der Veen Effect of clomifene citrate plus metformin and clomifene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinical trial BMJ, June 24, 2006; 332(7556): 1485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.M.E.W. Heijnen, M.J.C. Eijkemans, E.G. Hughes, J.S.E. Laven, N.S. Macklon, and B.C.J.M. Fauser A meta-analysis of outcomes of conventional IVF in women with polycystic ovary syndrome Hum. Reprod. Update, January 1, 2006; 12(1): 13 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J.C. Eijkemans, S. Polinder, A. G.M.G.J. Mulders, J. S.E. Laven, J.D. F. Habbema, and B. C.J.M. Fauser Individualized cost-effective conventional ovulation induction treatment in normogonadotrophic anovulatory infertility (WHO group 2) Hum. Reprod., October 1, 2005; 20(10): 2830 - 2837. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. E. Messinis Ovulation induction: a mini review Hum. Reprod., October 1, 2005; 20(10): 2688 - 2697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kashyap, G. A. Wells, and Z. Rosenwaks Insulin-sensitizing agents as primary therapy for patients with polycystic ovarian syndrome Hum. Reprod., November 1, 2004; 19(11): 2474 - 2483. [Abstract] [Full Text] [PDF]
|
|