Chronic Low-dose Step-up Protocol in Treating Women with Unexplained Infertility: (37.5 Units Versus 75 Units of Follitropin Alpha as the Initial Dose)
Ibrahim Polat
Department of Obgyn, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Altınsehir Mah. Turgut Ozal Cad. No:1, Atakent, Kucukcekmece, Istanbul, Turkey.
Gonca Yetkin Yildirim
Department of Obgyn, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Altınsehir Mah. Turgut Ozal Cad. No:1, Atakent, Kucukcekmece, Istanbul, Turkey.
Eser S. Ozyurek *
Department of Obgyn, Bagcilar Research and Training Hospital, Merkez Mahallesi Mimar Sinan Caddesi 6, Sokak, Bagcilar-Istanbul, Turkey.
Vuslat Lale Bakir
Department of Obgyn, Millet Caddesi, Haseki Research and Training Hospital, Aksaray-Fatih Istanbul, Turkey.
Ali Ekiz
Department of Obgyn, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Altınsehir Mah. Turgut Ozal Cad. No:1, Atakent, Kucukcekmece, Istanbul, Turkey.
Deniz Acar
Department of Obgyn, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Altınsehir Mah. Turgut Ozal Cad. No:1, Atakent, Kucukcekmece, Istanbul, Turkey.
Merve Aldıkactioglu Talmac
Department of Obgyn, Istanbul Kanuni Sultan Suleyman Research and Training Hospital, Altınsehir Mah. Turgut Ozal Cad. No:1, Atakent, Kucukcekmece, Istanbul, Turkey.
*Author to whom correspondence should be addressed.
Abstract
Aims: To compare the treatment outcome of the 37.5 Units/day follitropin-alpha (Study Group) with 75 Units/day (Control Group) as the initial dose for chronic low-dose step-up ovulation induction for unexplained infertile, non-PCOS (polycystic ovarian syndrome) women.
Methodology: Retrospective study and comparison of the patient characteristics and treatment outcome of 2 patient groups of 100 patient-cycles (Study and Control groups: Low-dose step-up cycles with initial doses of 37.5 Units/day and 75 Units/day, respectively). 95 (Study group) and 98(Control group) ovulatory cycles were included in the final analysis.
Results: Cycle cancellations were less common in the Study Group (6.3% vs 15.3%; P=0.02); those in the control group being mostly due to excessive response. The conception rates were similar: 11.5% and 11.2% in the study and the control groups, respectively. Total and mean daily gonadotropin used were lower in the study group (P=0.02 and P=0.04). 1 mild OHSS (Ovarian hyperstimulation syndrome) was observed in each group. There were no multiple pregnancies in either group.
Conclusion: The initial daily dose of 37.5 Unit/day is more effective in achieving a unifollicular cycle while being as safe and effective as 75 Units/day; requiring a lower amount of gonadotropin for the conventional treatment of unexplained infertility in non-PCOS women.
Keywords: Unexplained infertility, low-dose step-up, ovulation induction, intrauterine insemination