Ovulation rate and cycle characteristics in a subsequent clomiphene citrate cycle after stair step protocol

The ovulatory dose in the clomiphene citrate (CC) stair-step protocol is effective in inducing ovulation in most patients undergoing a subsequent CC cycle.

Tara H. Budinetz, D.O., Claudio A. Benadiva, M.D., H.C.L.D., Daniel W. Griffin, M.D., Lawrence L. Engmann, M.D., John C. Nulsen, M.D., Andrea J. DiLuigi, M.D.

Volume 103, Issue 3, Pages 675-679


To determine the ovulation rate after ovulation induction with clomiphene citrate (CC) in women who had previously been ovulatory after a stair-step (CC-SS) ovulation induction.

Retrospective cohort.

University–based tertiary fertility center.

61 anovulatory patients

Ovulation induction with CC.

Main Outcome Measure(s):
Ovulation rates and cycle characteristics.

Of 61 patients who underwent a subsequent CC cycle, 15 (25%) failed to ovulate at the previously ovulatory dose. Of those 15 patients, 13 (86.7%) ovulated after an increase in dose. The total number of follicles ≥15 mm (2.8 ± 1.2 vs. 1.6 ± 0.7) and peak estradiol (E2) levels (604 ± 272 pg/mL vs. 447 ± 218 pg/mL) were statistically significantly higher in the CC-SS cycle compared with the subsequent CC cycle, respectively. The endometrial lining was statistically significantly thinner in the CC-SS than the CC cycle (7.8 ± 1.8 vs. 9.2 ± 2.7, respectively).

The majority of patients who ovulate after a CC-SS protocol will ovulate after taking the previously ovulatory CC dose in a subsequent cycle. Those who do not ovulate will likely ovulate with a further increase in CC dose.

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