Anti-Müllerian hormone, visceral fat, and ovarian stromal Doppler to predict response to ovulation induction in polycystic ovary syndrome

Abstract

Objective This study was designed to identify whether visceral adiposity, anti-Mόllerian hormone, and ovarian stromal Doppler assessed during initial screening could predict the response to ovulation induction with clomiphene citrate in patients with polycystic ovary syndrome. Background The first choice of drug in women with polycystic ovary syndrome is clomiphene citrate. Three-quarters of women with polycystic ovary syndrome will ovulate with clomiphene citrate. Patients who do not ovulate on the maximum dose of 150 mg are considered to be clomiphene citrate resistant. Several parameters have been used to predict ovarian response in polycystic ovary syndrome patients. Patients and methods The study was carried out on 150 patients with polycystic ovary syndrome. Initial clomiphene citrate doses were 50 mg daily for 5 days starting on cycle day 3. In the absence of response, doses were increased to 100 and 150 mg daily in subsequent cycles. First ovulation with clomiphene citrate was used as the endpoint. Results At the end of the follow-up period, 110 (73.3%) patients had ovulated. Anti-Mόllerian hormone, visceral fat area assessed with computed tomography, and ovarian stromal pulsatility index were significantly different between responders and nonresponders. The cutoff levels for visceral fat area, anti-Mόllerian hormone, and ovarian stromal pulsatility index for predicting clomiphene citrate resistance were 83.6 cm 2 or more (area under the curve 0.79), 3.2 ng/ml or more (area under the curve 0.79), and 0.92 or less (area under the curve 0.66), respectively. Area under the curve for a multivariate prediction model was 0.87. Conclusion Clomiphene citrate-resistant polycystic ovary syndrome patients can be predicted on the basis of initial characteristics such as visceral fat area, anti-Mόllerian hormone levels, and ovarian stromal pulsatility index. This can help in patient selection and counseling regarding the success of ovulation induction.