Usefulness of intermittent clomiphene citrate treatment for women with polycystic ovarian syndrome that is resistant to standard clomiphene citrate treatment Original paper

What was studied?

The study investigated the efficacy of intermittent clomiphene citrate treatment (ICT) in women with polycystic ovary syndrome (PCOS) who were resistant to standard clomiphene citrate (CC) treatment. Clomiphene citrate is commonly used to induce ovulation in women with PCOS; however, some women do not respond to the standard treatment. This research aimed to assess whether a modified dosing schedule, using intermittent CC treatment, could help induce follicular growth in these resistant patients.

Who was studied?

The study focused on 42 infertile women diagnosed with PCOS who were resistant to standard CC treatment. Of these, 26 women underwent the intermittent CC treatment protocol, and their response to the treatment was monitored and analyzed. The patient cohort was selected based on their non-response to the standard 50 mg/day, 5-day CC regimen, which is typically used as a first-line treatment for anovulatory PCOS.

What were the most important findings?

The study found that intermittent CC treatment was highly effective for women who were resistant to standard CC treatment. The protocol involved administering 100 mg of CC for 5-day periods across different phases of the menstrual cycle. The results showed that 80.8% of the patients who had previously been resistant to standard CC treatment responded positively to ICT, with follicular growth observed in many of the cases. Notably, the majority of those who responded had only a single mature follicle, which is a safer outcome in terms of reducing the risk of multiple pregnancies or ovarian hyperstimulation syndrome (OHSS). Additionally, no cases of OHSS or multiple pregnancies were reported, making ICT a promising alternative to gonadotropin therapy, which carries higher risks and requires more intensive treatment.

The efficacy of ICT was particularly notable in patients resistant to the 100 mg dose of CC, where up to 78.2% responded positively after subsequent doses. This suggests that ICT may be more effective than simply increasing the dose of standard CC, providing a less invasive and lower-risk alternative for patients who fail the initial treatment.

What are the greatest implications of this study?

The findings suggest that ICT could become a preferred treatment option for women with CC-resistant PCOS before advancing to gonadotropin therapy. ICT offers several advantages: it is less invasive, more cost-effective, and poses a lower risk of complications like OHSS and multiple pregnancies. By maintaining high serum FSH levels through repeated administration of CC, ICT seems to trigger follicular growth effectively without the need for prolonged or more invasive treatments. The study’s outcomes could help reshape the treatment protocols for PCOS, offering a safer, more accessible alternative to gonadotropin therapy. However, further research with larger patient populations is necessary to validate these findings and assess the long-term efficacy of ICT in achieving successful pregnancy outcomes.