Managing CC resistant Pr subfertile women who are relatively young?? · CC Resistant in a case of primary infertility with the provisional diag of PCOD. If clomiphene fails to ovulate after 3-4 cycles-then what ? In addition to diet control, achieving optimum BMI, Life style modifications what option we have ??
· CC Resistant because she did not respond to 100 mg of clomiphene citrate/ later 150 mg CC for several cycles even after due monitoring of the M cycles. No dev of follicles. Now the Q before us what are the steps that we can be adopted in such CC resistant case ? Should we go for gonadotrophins? If so what kind of gonadotrophins?? Before going for HMG is there any other protocol? That will depend on her age, AMH, baseline FSH, LH, E -2, and also for how long she is taking Metformin and what dose?
Option 1: -- CC + Inj r-FSH, along with follicular monitoring but after exclusion of high DHEASO4 & PRL . any are of opinion that for PCOD p-FSH or better still r-FSH is better than u-HMG. But ,understandably opinion differs.
Option B) One may consider: - Cc+steroids if DHEASO4 high.
Option C:-If the couple can’t afford for high cost Tr of r-FSH & costs of monitoring than -one may try Myoinositol & NAC ( N-acetyl-cosine combination ) if couple is young for 2-3 months and then try induction with CC & r-FSH
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