Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary

Abstract

Background: As Clomiphene citrate (CC) is widely used in treatment of infertility in polycystic ovarian syndrome (PCOS). Aim: To evaluate rate of ovulation using CC “stair step protocol” compared to “traditional protocol”. Methods: A randomized clinical trial conducted on 60 infertile PCO were randomly divided to 2 groups, group (A) “Stair Step protocol” in which CC was administrated on day 2 to day 6 of menses then transvaginal ultrasound (TVUS) was done, if follicular diameter less than 18 mm on day 14 increasing dose to 100 mg days for further 5 days, then TVUS on day 21, if no response, an increasing the dose to 150 mg daily. In group (B), “Traditional protocol” started with CC 50 mg on day 2 to day 6 of menses, if no response, in subsequent cycles the dose increased by 50 mg till dose 150 mg daily.Metformin dose was 500mg daily then increased weekly by 500 mg till 1500 mg daily.Results: the rate of ovulation and pregnancy were higher in the stair-step than the traditional group (76.7 vs. 63.3 %, respectively) (40 vs. 26.7 %, respectively). With significantly shorter duration of treatment was in stair-step than traditional protocol (21 ± 7.0 vs. 49 ± 24 days, respectively).Conclusion: the stair step protocol has a higher efficacy than traditional protocol.Synopsis: stair step protocol has higher ovulation and pregnancy rate and significant shorter duration of treatment making it superior on traditional protocol.