Rationale:
There is some information suggesting that a progesterone-induced withdrawal bleeding before
the start of ovulation induction in women suffering from oligo- or amenorrhea reduces
pregnancy and live birth rate.
Objective:
To evaluate the effects of withholding progesterone-induced endometrial withdrawal bleeding
before ovulation induction on the time to pregnancy and the ongoing pregnancy rate.
Study design:
Prospective multicenter randomized controlled feasibility study
Study population:
Women with oligomenorrhea or amenorrhea according to WHO classification category 2
Intervention:
Patients will be randomized to receive one of the following two treatments:
Stair step group: blind start ovulation induction (no progesterone induced withdrawal
bleeding and stair step protocol in case of treatment failure.
Control: standard care; a progesterone induced withdrawal bleeding in case of no spontaneous
menses before starting an ovulation induction cycle and in between anovulatory cycles.
Main study parameters/endpoints:
The primary endpoints are the time to pregnancy and ongoing pregnancy rate within a treatment
horizon of 3 cycles. Secondary endpoints include time to ovulation, endometrial thickness,
multiple pregnancy and the incidence of treatment failure.
Nature and extent of the burden and risks associated with participation, benefit and group
relatedness:
The number of site visits or physical examinations will not differ from accepted clinical
practice.