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PubMed · 15744186

Abnormal vs. dysfunctional uterine bleeding: what's the difference?

Denise M McEnroe Ayers·Joan E Stucky Lappin·Linda McIntosh Liptok
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Abstract

Sort out the differences between uterine bleeding that's abnormal and that which is dysfunctional. Then teach your patient about new treatments that are available for these sometimes-dangerous conditions.

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AnovulationFemaleHumansMenorrhagiaMetrorrhagiaUterine HemorrhageJournal Article

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BibTeXRIS

Denise M McEnroe Ayers, Joan E Stucky Lappin, Linda McIntosh Liptok. 2004. Abnormal vs. dysfunctional uterine bleeding: what's the difference?. https://doi.org/10.1097/00152193-200411002-00006

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Does previous response to clomifene citrate influence the selection of gonadotropin dosage given in subsequent superovulation treatment cycles?

PURPOSE: To determine whether ovarian response to previous clomifene treatment could influence the selection of the starting dose of gonadotropins in subsequent in vitro fertilization (IVF) or intra uterine insemination (IUI). METHODS: Forty three anovular women who had received clomifene for ovulation induction followed by gonadotropins for IUI or IVF superovulation were reviewed retrospectively. Data on gonadotropin dose were compared between clomifene-resistant patients and clomifene responders. RESULTS: IVF patients who had had prior superovulation/IUI treatment received similar doses of gonadotropins regardless of response to clomifene (1610 IU versus 1560 IU, p = 0.74). In IVF patients not receiving prior IUI treatment, the clomifene-resistant women were given higher doses of gonadotropins than those responding to clomifene (2500 IU versus 1440 IU, p = 0.042). CONCLUSIONS: We found that, in our Unit, clinicians appeared to use prior non-response to clomifene as a reason for prescribing a higher starting dose of gonadotropins in IVF treatment, a practice that is not evidence-based.

Anovulation↗
PubMed2006

The use of a decremental dose regimen in patients treated with a chronic low-dose step-up protocol for WHO Group II anovulation: a prospective randomized multicentre study.

BACKGROUND: In women with chronic anovulation, the choice of the FSH starting dose and the modality of subsequent dose adjustments are critical in controlling the risk of overstimulation. The aim of this prospective randomized study was to assess the efficacy and safety of a decremental FSH dose regimen applied once the leading follicle was 10-13 mm in diameter in women treated for WHO Group II anovulation according to a chronic low-dose (CLD; 75 IU FSH for 14 days with 37.5 IU increment) step-up protocol. METHODS: Two hundred and nine subfertile women were treated with recombinant human FSH (r-hFSH) (Gonal-f) for ovulation induction according to a CLD step-up regimen. When the leading follicle reached a diameter of 10-13 mm, 158 participants were randomized by means of a computer-generated list to receive either the same FSH dose required to achieve the threshold for follicular development (CLD regimen) or half of this FSH dose [sequential (SQ) regimen]. HCG was administered only if not more than three follicles >or=16 mm in diameter were present and/or serum estradiol (E(2)) values were <1200 pg/ml. The primary outcome measure was the number of follicles >or=16 mm in size at the time of hCG administration. RESULTS: Clinical characteristics and ovarian parameters at the time of randomization were similar in the two groups. Both CLD and SQ protocols achieved similar follicular growth as regards the total number of follicles and medium-sized or mature follicles (>/=16 mm: 1.5 +/- 0.9 versus 1.4 +/- 0.7, respectively). Furthermore, serum E(2) levels were equivalent in the two groups at the time of hCG administration (441 +/- 360 versus 425 +/- 480 pg/ml for CLD and SQ protocols, respectively). The rate of mono-follicular development was identical as well as the percentage of patients who ovulated and achieved pregnancy. CONCLUSIONS: The results show that the CLD step-up regimen for FSH administration is efficacious and safe for promoting mono-follicular ovulation in women with WHO Group II anovulation. This study confirms that maintaining the same FSH starting dose for 14 days before increasing the dose in step-up regimen is critical to adequately control the risk of over-response. Strict application of CLD regimen should be recommended in women with WHO Group II anovulation.

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