Sequential low-dose step-up and step-down protocols with recombinant follicle-stimulating hormone in polycystic ovary syndrome: prospective comparison with step-down protocol.

PURPOSE: To assess the differences in follicular development comparing two sequential low-dose step-up and step-down protocols (A: 37.5 IU/day, B: 75 IU/day) with a step-down protocol (C: 150 IU/day) using recombinant human follicle stimulating hormone (rFSH) in women with polycystic ovarian syndrome (PCOS). METHODS: In this prospective observational comparative study, 60 PCOS women were treated with one of the three protocols for only one cycle. RESULT(S): Monofollicular development was similar among the three protocols but the total number of follicles >10 mm in diameter was significantly lower in group A (1 ± 0.94 vs 6.3 ± 2.45 vs 8.6 ± 4.45; P = 0.001 A vs B; P < 0.001 A vs C). Cycle cancellation rate was higher in protocol A and in protocol C because of no ovarian response and excessive multifollicular development, respectively. The total amount of rFSH for complete cycle was significantly lower in protocol A (P = 0.02 A vs B; P = 0.007 A vs C). No mild or severe hyperstimulation syndrome (OHSS) was observed. CONCLUSION(S): A and B protocols seem to be a more effective approach than the step-down protocol. In both groups, the pregnancy rate for started cycle was the same. Protocol A has allowed the development of a lower number of small follicles, single pregnancies, but an excessive number of cancelled cycles occurred. In protocol B no cycle cancellation occurred, though the total rFSH dosage was significantly higher than the protocol A and two twin pregnancies were observed.