Ovulation induction using low-dose step-up rFSH in Vietnamese women with polycystic ovary syndrome

The aim of this study was to assess the effectiveness and safety of a low-dose step-up protocol with a recombinant FSH starting dose of 25 IU for ovulation induction in anovulatory patients with polycystic ovary syndrome (PCOS) and a normal or low body mass index (BMI). In this prospective, non-comparative, open trial, 183 PCOS patients who had three unsuccessful cycles of ovulation induction with clomiphene citrate received recombinant FSH (Puregon®) 25 IU/day for 14 days, the dose was then increased by 25 IU every 5 days if there was no follicle of >12 mm diameter (maximum 150 IU/day). Human chorionic gonadotrophin was administered when the lead follicle was ≥18 mm, and intrauterine insemination was performed 36 h later. Duration of stimulation was 15.9 ± 4.8 days and total FSH dose was 484 ± 257 IU. A developing follicle was observed in 96.7% of cycles, of which 62.1% had unifollicular development and 15.8% were cancelled due to over-response. The clinical and ongoing pregnancy rates were 35.5% and 33.9%, respectively. There were no multiple pregnancies, and only one case of mild ovarian hyperstimulation syndrome. A low-dose step-up protocol with a recombinant FSH starting dose of 25 IU/day is effective and safe in anovulatory Vietnamese PCOS patients with a low or normal BMI.