INCREASE IN ANDROGEN-ESTROGEN RATIO SPECIFICALLY DURING LOW-DOSE FOLLICLE-STIMULATING-HORMONE THERAPY FOR POLYCYSTIC-OVARY-SYNDROME

Objectives: To compare changes in serum androgens in women with polycystic ovary syndrome (PCOS) during ovulation induction with low-dose versus conventional urofollitropin. Design: Prospective case-control study. Setting: Tertiary-care reproductive medicine center. Subjects: Thirty-three women with PCOS who failed to conceive with clomiphene citrate therapy. Interventions: Urofollitropin (low-dose, 75 IU; conventional dose, 150 IU) was administered IM daily. Therapy was monitored by serum E(2) and vaginal sonography. Hormone determinations were performed by immunoassay. Main Outcome Measures: Serum E(2), androstenedione (A), T, and LH levels. Results: On the day of hCG administration, patients treated with low-dose therapy exhibited significantly higher ratios of A to E(2) (3.5 +/- 0.5 versus 2.2 +/- 0.3 [mean +/- SEM]) and T to E(2) (1.5 +/- 0.3 versus 1.0 +/- 0.1) compared with conventional urofollitropin therapy. The number of follicles greater than or equal to 16 mm in diameter was significantly lower with low-dose therapy (2.7 +/- 0.6 versus 5.4 +/- 0.4). Conclusions: Although low-dose therapy was associated with a reduction in the number of recruited follicles, the increase in androgen to E(2) associated with this therapy may adversely affect oocyte quality and may explain the relatively high miscarriage rate reported in PCOS patients with this therapy.