Treatment of chronic anovulation resistant to clomiphene citrate (CC) by using oral contraceptive ovarian suppression followed by repeat CC treatment.

OBJECTIVE: To evaluate the effectiveness of a 2-month oral contraceptive (OC) ovarian suppression followed by clomiphene citrate (CC) in patients who had failed to ovulate on maximum doses of CC alone.
DESIGN: Prospective, nonrandomized observational study.
SETTING: Private tertiary infertility center. PATIENT(S): Thirty-eight patients with documented anovulation by transvaginal ultrasound follicular monitoring while receiving CC in doses of 150 mg or higher. INTERVENTION(S): Two-month ovarian-hypothalamic-pituitary axis suppression with OCs followed by repeat CC 100 mg for 5 days. MAIN OUTCOME MEASURE(S): Follicle growth, endometrial development, and ovulation were confirmed by transvaginal ultrasound. Pregnancy was confirmed by serum hCG levels and 7-week gestation ultrasound. RESULT(S): Thirty-eight patients completed 95 treatment cycles. Twenty-nine patients became ovulatory (76%), and 69 of the 95 cycles were ovulatory (72.6%), resulting in 22 pregnancies in the 38 patients for a cumulative pregnancy rate of 58%. CONCLUSION(S): Suppression of the hypothalamic-pituitary-ovarian axis for 2 months with OCs followed by CC treatment results in excellent rates of ovulation and pregnancy in women who had previously failed to ovulate on CC alone. This treatment offers an effective, reasonable, inexpensive, and low-risk alternative before gonadotropin therapy.