Management of gonadotrophin-induced cycles characterized by a significant discrepancy between oestrogen levels and dominant follicle size

The incongruity between oestrogen elevation and immature follicles is one of the problems encountered during the induction of ovulation with gonadotrophins. This phenomenon is particularly pertinent in women with polycystic ovarian disease. Our work presents a regimen of treatment that was found helpful in overcoming this problem. It is based on a close ultrasonic assessment of the follicular growth, which also serves as the sole means for the decision of human chorionic gonadotrophin (HCG) administration (mature follicle range is 19-25 mm). Accordingly, the human menopausal gonadotrophin doses were individually adjusted and, if necessary, omitted in an effort to avoid excessive oestrogen elevation at the time of HCG administration. The resultant plateau or decline of oestrogen levels in our series do not interfere with ovulation. Seventeen conceptions occurred after 53 treatment cycles in 19 women.