Gestagen versus oral contraceptive pills to induce withdrawal bleeding before induction of ovulation by clomiphene citrate in polycystic ovary syndrome

ObjectiveTo compare between gestagen versus oral contraceptive pills to induce withdrawal bleeding before induction of ovulation by clomiphene citrate in polycystic ovary syndrome.DesignRandomized controlled trial.SettingIntegrated Fertility Center and Agial Fertility Center.SampleFifty PCO female patients.MethodsThe patients were subdivided in 2 groups according to computer generated randomized program:Group I: Twenty five PCO female patients treated by cidolut nor 5 mg tablets (two tablets every day for 5 days).Group II: Twenty five PCO female patients treated by cilest tablets (one tablet every day for 21 days).All patients were observed until withdrawal bleeding followed by ovulation induction by clomiphene citrate from the second day of menses (100 mg per day for 5 days). The patients were then followed up by:-transvaginal ultrasound follicular scanning in days 10, 12, and 14 of withdrawal bleeding until ovulation was detected with additional evaluation of the endometrial thickness and pattern-serum progesterone was measured 7 days after the expected day of ovulation-pregnancy test 15 days after ovulation to detect pregnancy and 2 weeks later by U/S to detect fetal pulsation.Main outcome measuresEndometrial thickness, number of mature follicles and serum progesterone level on day o f ovulation, and clinical pregnancy rate.ResultsThere was no significant difference between the two groups regarding pregnancy rate.ConclusionsA few studies show an apparent use of oral contraceptive pills in the improvement of ovulation induction by clomiphene citrate. Despite this, from the available data a causal relationship is not confirmed, so large prospective studies using larger sample size, and longer duration of treatment are needed. Meanwhile, close clinical surveillance of patients being treated with oral contraceptive pills is required.