Ovulation Induction Using Clomiphene Citrate Using Stair – Step Regimen versus Traditional Regimen in Polycystic Ovary Syndrome Women – A Randomized Control Trial

OBJECTIVE: To determine the efficacy of the stair-step protocol (SSP) using clomiphene citrate (CC) in patients with polycystic ovary syndrome (PCOS) and compare it with traditional regimen. DESIGN: This was randomized control trial. SETTING: Infertility Clinic. PATIENT(S): Sixty infertile PCOS women. INTERVENTION(S): Patients were randomized into the study (SSP – 30 patients) and control group (traditional protocol – 30 patients). In the SSP, patients were treated with CC 50 mg/day for 5 days and in nonresponsive patients, the dosage was increased to 100 mg/day for 5 days in the same cycle. Maximum dose of 150 mg was given until the dominant follicle was generated. In control group, the dose increment in nonovulatory cases was done in subsequent cycle. Ultrasonography follow-up was done to detect ovulation. MAIN OUTCOME MEASURE(S): Ovulation rate and duration of treatment. RESULTS: Ovulation (66.7% vs. 50% respectively) and pregnancy rates (26.7% vs. 15.7%) were similar between the stair step and the control group. The duration of treatment was significantly shorter in stair step compared to traditional protocol (17.23 vs. 53 days). CC 100 mg was the most effective dose for ovulation in either group. There were no significant differences in the systemic side effect. CONCLUSIONS: By using SSP, effective treatment is provided in significantly shorter time period without any detrimental effect on the ovulation and pregnancy rates.