Purified follicle-stimulating hormone in polycystic ovary syndrome: slow administration is safer and more effective.

Twenty-seven infertile patients presenting with clomiphene citrate- (CC) resistant polycystic ovary syndrome (PCOS) were treated with purified urinary follicle-stimulating hormone (pFSH). We compared the conventional stepwise protocol with a slow protocol starting with 75 IU/d, not increased until 14 days, supplemented by human chorionic gonadotropins (hCG). The slow protocol was characterized by a slightly longer duration of stimulation but a more physiological ovarian response (mono- or biovulatory cycles in 70% versus 19% with the conventional protocol, less follicles, and a lower plasma estradiol [E2] resulting in significantly less discontinuation of treatment for risk of hyperstimulation or multiple birth). The pregnancy rate per cycle was higher with the slow protocol (23% versus 15%). The slow protocol could thus be the treatment of choice for CC-resistant PCOS, as it appeared safer and more effective.