Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary
Ghareeb, W., Ahmed, N., Madny, E., Ashour, O. (2024). Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary. EKB Journal Management System, 28(1), 57-64. doi: 10.21608/egyfs.2024.345941
Waleed F. Ghareeb; Nourhan Ez-Eldeen Ahmed; Elham H. Madny; Osama E. Ashour. "Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary". EKB Journal Management System, 28, 1, 2024, 57-64. doi: 10.21608/egyfs.2024.345941
Ghareeb, W., Ahmed, N., Madny, E., Ashour, O. (2024). 'Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary', EKB Journal Management System, 28(1), pp. 57-64. doi: 10.21608/egyfs.2024.345941
Ghareeb, W., Ahmed, N., Madny, E., Ashour, O. Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary. EKB Journal Management System, 2024; 28(1): 57-64. doi: 10.21608/egyfs.2024.345941

Comparison between Clomiphene Citrate / Metformin Stair Step Protocol and Traditional Protocol in Treatment of Polycystic Ovary

The Egyptian Journal of Fertility of Sterility
Article 8, Volume 28, Issue 1 - Serial Number 11106352, January 2024, Page 57-64  XML PDF (3.26 MB)
Document Type: Original Article
DOI: 10.21608/egyfs.2024.345941
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Authors
Waleed F. Ghareeb1; Nourhan Ez-Eldeen Ahmed email 2, 3; Elham H. Madny4; Osama E. Ashour5, 6
11. Assistant professor of Obstetrics & Gynecology, Faculty of Medicine-Suez Canal University, Ismailia, Egypt
2Resident of Obstetrics & Gynecology, Faculty of Medicine-Suez Canal University, Ismailia, Egypt
3M.B.B.CH 2018, Suez Canal University, Resident of Obstetrics & Gynecology, Faculty of Medicine, Suez Canal University Hospitals, Ismailia, Egypt
4Professor of Obstetrics & Gynecology, Faculty of Medicine-Suez Canal University, Ismailia, Egypt
5Lecturer of Obstetrics & Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
6Department of obstetrics and gynecology, faculty of medicine, Suez Canal University Hospital, Ismailia, Egypt
Abstract
Background: As Clomiphene citrate (CC) is widely used in treatment of infertility in polycystic ovarian syndrome (PCOS).  
Aim: To evaluate rate of ovulation using CC “stair step protocol” compared to “traditional protocol”. 
Methods: A randomized clinical trial conducted on 60 infertile PCO were randomly divided to 2 groups, group (A) “Stair Step protocol” in which CC was administrated on day 2 to day 6 of menses then transvaginal ultrasound (TVUS) was done, if follicular diameter less than 18 mm on day 14 increasing dose to 100 mg days for further 5 days, then TVUS on day 21, if no response, an increasing the dose to 150 mg daily. In group (B), “Traditional protocol” started with CC 50 mg on day 2 to day 6 of menses, if no response, in subsequent cycles the dose increased by 50 mg till dose 150 mg daily.
Metformin dose was 500mg daily then increased weekly by 500 mg till 1500 mg daily.
Results: the rate of ovulation and pregnancy were higher in the stair-step than the traditional group (76.7 vs. 63.3 %, respectively) (40 vs. 26.7 %, respectively). With significantly shorter duration of treatment was in stair-step than traditional protocol (21 ± 7.0 vs. 49 ± 24 days, respectively).
Conclusion: the stair step protocol has a higher efficacy than traditional protocol.
Synopsis: stair step protocol has higher ovulation and pregnancy rate and significant shorter duration of treatment making it superior on traditional protocol. 
Keywords
Keywords: Clomiphene citrate; metformin; ovulation; stair-step
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