gynecology and obstetrics medical project, gynecology journal, obstetrics, gynecologic oncology, reproductive medicine, gynecological endoscopy, ultrasonography, gynecology articles

Ginekologia i Poloznictwo
ISSN 1896-3315 e-ISSN 1898-0759

Different variables predicting ovulatory response among clomiphene citrate resistance and clomiphene citrate sensitive patients with polycystic ovarian syndrome


Author(s): Mohamed Mahmoud Samy, Alaa Sherif Zakaria Saad*, Ahmed Abdelkader Fahmy, Ahmed Mohamed Rateb and Bassem Ali Islam

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrinological disorder seen in 6%–10% of women. It is a syndrome that manifests variably from adolescence as oligomenorrhea or hirsutism or obesity and goes on to affect the reproductive performance of the female by causing anovulation. Although lifestyle modification is known to improve reproductive outcomes in females with PCOS, the standard gold treatment for norm-gonadotropic oligo/amenorrheic infertility (WHO Group II) was clomiphene citrate (CC) (3) until 2018.

Background: The purpose of the study was to evaluate the role of clinical, metabolic, hormonal, and ultrasound features of women with PCOS in predicting the response to clomiphene citrate.

Patients & methods: This Prospective Observational study included 100 women with PCOs according to Rotterdam’s criteria at Ain Shams University Maternity Hospital from June 2020 to January 2022. All patients were treated with CC (Clomiphene Citrate) according to the stair-step approach. Medroxyprogesterone (10 mg/d Provera for 10 days) was given to induce withdrawal bleeding to start these steps again in a new cycle if the patient was known to have oligomenorrhea. These steps were repeated for 3cycles before declaring the patient CC resistant. Due to the debatable effect of CC on the endometrium, all patients had Estradiol valerate 2 mg pills (cycloprogenova®) from the 11th day of the cycle. Response to CC was ovulation which was assessed either by TVUS or by serum progesterone level.

Results: Of the total 100 PCOS women, 42 (49.4%) were CC resistant and 43 (50.6%) were CC sensitive, and 15 were dropouts. Of the 43 PCOS women who ovulated, maximum, i.e., 25 (58.1%) women ovulated with 100 mg CC. The most significant diagnostic feature of PCOS in this study was a BMI of ≤27.8 (kg/m2) with a specificity of 88.1%. CC-resistant PCOS women had significantly higher body mass index (BMI), TSH, and Serum Prolactin and were also associated with apple and pear-shaped WHR. Longer menstrual cycles were significantly more common in the CC-resistant group.

Conclusion: Clomiphene-sensitive PCOS women have significantly shorter cycles, lower BMI, Avocado-shaped WHR, and low TSH and Prolactin levels. These parameters should be considered while deciding on the ovulation induction protocol. Trial registration: Clinical Trial registration number is: NCT03206892.