Ovulation induction with low doses of "pure" follicle stimulating hormone using a fixed protocol in patients with polycystic ovarian disease.

OBJECTIVE

Use of a low, fixed dose of purified FSH to induce ovulation in polycystic ovarian syndrome.

DESIGN

Fixed protocol, using 75 IU/day of "pure" FSH starting on day 1-5 of menses.

SETTING

University outpatient clinic.

PATIENTS AND INTERVENTIONS: Seventeen patients, aged 18-38, with clomiphene-resistant polycystic ovarian syndrome, for 23 cycles. All received 50 mg medroxyprogesterone to induce menstrual flow. "Pure" FSH given i.m. for eight to ten days. If follicle reached > or = 18 mm, hCG (5,000 IU) was given, in one-half of cases, in a single dose to induce rupture.

MAIN OUTCOME MEASURES: Hormonal measurements (plasma LH, FSH, estradiol, testosterone, progesterone); daily, LH/FSH ratio; daily abdominal sonogram.

RESULTS

I: No follicular growth (3 cycles; 13%); II: Inadequate follicular growth (< or = 14 mm--6 cycles; 26%); IIIa: Follicle > or = 18 mm, hCG given; 100% ovulatory; IIIb: Follicle > or = 18 mm, no hCG given; 2/7 ovulatory. Hyperstimulation: one (moderate) in IIIa; one (mild) in IIIb.

CONCLUSIONS

Fixed protocol of low-dose, "pure" FSH produces good results, especially combined with hCG, which is effective up to 48 hours after last injection of FSH.