Human Reproduction, Vol. 18, No. 8, 1626-1631,
August 2003
© 2003 European Society of Human Reproduction and Embryology
A comparative randomized multicentric study comparing the step-up versus step-down protocol in polycystic ovary syndrome
1 Reproductive Endocrine Unit, EA 1533, Hôpital Saint-Antoine, 75012 Paris and 2 Reproductive Medicine Unit, Hôpital Jean Verdier, 93143 Bondy, France
3 To whom correspondence should be addressed: e-mail: sophie.christin-maitre{at}sat.ap-hop.paris.fr
BACKGROUND: The aim of the study was to evaluate follicular development and ovulation comparing the low-dose step-up and the step-down protocols, in women with clomiphene citrate (CC)-resistant polycystic ovaries. METHODS: Eighty-three women were randomized, and treated with recombinant (r) FSH (Puregon®) using either the step-up (n = 44) or step-down (n = 39) protocol. They were followed up for three cycles unless pregnancy occurred. RESULTS: Monofollicular development occurred in 68.2% of the 85 cycles in the step-up group, as compared with 32% of the 72 cycles in the step-down group (P < 0.0001). Hyperstimulation was statistically less frequent using the step-up procedure (4.7 versus 36%, P < 0.0001). Both protocols used the same number of FSH units per cycle (951 ± 586 versus 967 ± 458 in step-up and step-down respectively, P = not significant). However, the duration of ovarian stimulation was statistically different (15.2 ± 7.0 days in step-up versus 9.7 ± 3.1 in step-down, P < 0.001). Ovulation was observed in 70.3% of the cycles using the step-up procedure as compared with 51.3% using the step-down procedure (P < 0.01). The cumulative rate of clinical gestations during the study did not differ between the two groups (38.6% in the step-up versus 30.8% in the step-down procedure). CONCLUSIONS: The step-up protocol using rFSH (Puregon®), is more efficient in obtaining a monofollicular development and ovulation than the step-down protocol, in women with CC-resistant polycystic ovaries. Although the duration of stimulation is longer, the rate of ovarian hyperstimulation is much lower using the step-up protocol.
Key words: ovulation induction/polycystic ovary syndrome/recombinant FSH/step-down protocol/step-up protocol
* Members of the Recombinant FSH Study Group in alphabetical order: J.M.Antoine, Paris; C.Avril, Rouen; P.Bouchard, and S.Christin-Maitre, Paris; D.Dewailly, Lille; J.C.Emperaire, Bordeaux; P.Fénichel, Nice; R.Frydman, Clamart; B.Hedon, Montpellier; J.N.Hugues and I.Cedrin-Durnerin, Bondy; M.Leroy, Lille; G.Priou, Rennes; J.C.Sage Grenoble; J.Salat-Baroux and M.Savale, Paris (deceased).
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]
|
|
|
|
|
|
I. Cedrin-Durnerin, N. Massin, J. Galey-Fontaine, H. Bry-Gauillard, M. Roger, N. Lahlou, and J.N. Hugues Timing of FSH administration for ovarian stimulation in normo-ovulatory women: comparison of an early or a mid follicular phase initiation of a short-term treatment Hum. Reprod., November 1, 2006; 21(11): 2941 - 2947. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.N. Hugues, I. Cedrin-Durnerin, C.M. Howles, and On Behalf of the Recombinant FSH OI Study Group The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study Hum. Reprod., November 1, 2006; 21(11): 2817 - 2822. [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]
|
|
|
|
|
|
M. van Wely, N. Bayram, F. van der Veen, and P. M.M. Bossuyt Predicting ongoing pregnancy following ovulation induction with recombinant FSH in women with polycystic ovary syndrome Hum. Reprod., July 1, 2005; 20(7): 1827 - 1832. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. H. Balen, A. G. Mulders, B. C. Fauser, B. C. Schoot, M. A. Renier, P. Devroey, M. J. Struijs, and B. M. Mannaerts Pharmacodynamics of a Single Low Dose of Long-Acting Recombinant Follicle-Stimulating Hormone (FSH-Carboxy Terminal Peptide, Corifollitropin Alfa) in Women with World Health Organization Group II Anovulatory Infertility J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6297 - 6304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. van Wely, N. Bayram, P.M.M. Bossuyt, and F. van der Veen Laparoscopic electrocautery of the ovaries versus recombinant FSH in clomiphene citrate-resistant polycystic ovary syndrome. Impact on women's health-related quality of life Hum. Reprod., October 1, 2004; 19(10): 2244 - 2250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Bayram, M. van Wely, E. M Kaaijk, P. M M Bossuyt, and F. van der Veen Using an electrocautery strategy or recombinant follicle stimulating hormone to induce ovulation in polycystic ovary syndrome: randomised controlled trial BMJ, January 24, 2004; 328(7433): 192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.J.P. van Santbrink and B.C.J.M. Fauser Is there a future for ovulation induction in the current era of assisted reproduction? Hum. Reprod., December 1, 2003; 18(12): 2499 - 2502. [Abstract] [Full Text] [PDF]
|
|