Dr. magdy eldesouky :: Publications:

Clomiphene citrate (CC) is the traditional first-line treat- ment for chronic anovulation that characterizes polycystic ovary syndrome (PCOS) (1). Clomiphene citrate is accu- mulated in the body with low clearance rate and long half-life (5 days). Significant plasma concentrations of the active zu-isomer of CC can be detected up to 6 weeks after administration. However, 20%-25% of PCOS women fail to ovulate with incremental doses of CC. In addition, clinical data revealed a discrepancy between ovulation rates (75%-80%) and conception rates (30%-40%) during CC treatment (2). For these patients who do not respond to CC, there are a few limited adjunctive therapies that can be tried before moving on to gonadotropin therapy or laparo- scopic ovarian drilling, including bromocriptine (in the presence of hyperpolactinemia or galactorrhea), dexameth- asone (to reduce adrenal androgen production), insulin sensitizers (to treat hyperinsulinemia), oral contraceptives (for pretreatment suppression of LH), pulsatile GnRH (to preserve physiologic interactive feedback), and extended doses of CC (3). However, their usefulness is limited to specific abnormalities, because many women with CC fail- ure do not present with any overt signs of a treatable disorder (4).