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Human Reproduction, Vol. 8, No. 9, pp. 1367-1371, 1993
© 1993 European Society of Human Reproduction and Embryology

research-article

Endocrinology: The choice of treatment for anovulation associated with polycystic ovary syndrome following failure to conceive with clomiphene

J. Farhi, R. Homburg, A. Lerner and Z. Ben-Rafael1

Infertility Unit, Department of Obstetrics and Gynaecology, Golda Meir Medical Centre Hasharon, Petah-Tikva 49372 and Sackler School of Medicine, Tel Aviv University Israel

Correspondence: 1To whom correspondence should be addressed

The choice of treatment for clomiphene-resistant anovulation associated with polycystic ovary syndrome (PCOS) is presently arbitrary and selection criteria are not available. A total of 144 women with anovulatory infertility associated with PCOS who failed to conceive on clomiphene were treated with either pure follicle stimulating hormone (FSH) (n = 29), or human menopausal gonadotrophin (HMG) (n = 60), or gonadotrophin-releasing hormone analogue (GnRHa) and HMG (n = 55). Analysis of 306 treatment cycles and 53 pregnancies revealed a cumulative conception rate at 4 months of 23% with FSH, 47% with HMG and 69% with GnRHa + HMG. The miscarriage rate was highest in the HMG group (44%) and consequently the cumulative live birth rate was superior when GnRHa was used in combination with HMG. There were no significant differences in the basal clinical and endocrinological features of those who conceived compared with those who did not, either in the whole group, or in the individual treatment groups. Thus, the choice of treatment for clomiphene-resistant women with PCOS cannot be guided by the basal clinical or endocrinological features of this heterogeneous syndrome with the present state or knowledge.

Key words: anovulation/infertility treatment/polycystic ovary treatment


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