A 28-year-old woman with WHO Group II anovulation has been on clomiphene citrate 50 mg/day for 5 days for 3 cycles with documented follicular rupture. What is the recommended dose escalation for subsequent cycles if ovulation does not occur at this dose?
- A Increase to 100 mg/day for 5 days ✓
- B Increase to 150 mg/day for 8 days
- C Add gonadotropins in the same cycle
- D Switch to letrozole 2.5 mg/day
Correct answer: A. Increase to 100 mg/day for 5 days
Explanation
The standard step-up protocol for clomiphene citrate begins at 50 mg/day for 5 days, increasing by 50 mg increments in subsequent cycles up to a maximum of 150-250 mg/day. If 50 mg fails, the next step is 100 mg/day for 5 days. Option B incorrectly extends duration to 8 days. Option C describes add-on therapy, not dose escalation. Option D is an alternative agent but not the dose-escalation step.
Reference: Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.