Ovulation Induction Response in Non-Obese Versus Obese Women with Polycystic Ovarian Syndrome at Fertility Clinic of a Tertiary Care Hospital, Rawalpindi

Abstract

Background: More than 80% of premenopausal females presenting with Polycystic Ovarian Syndrome (PCOS) have above average BMI. Obesity enhances the magnitude of hormonal and metabolic disturbances leading to anovulation. Objective: To validate the influence of obesity on response of ovulation induction by Clomiphene citrate in PCOS related subfertility. Methodology; Study Design & Setting: Comparative Analytical study at Fertility Clinic of Department of Obstet & Gynae, Benazir Bhutto Hospital, Rawalpindi. Study Duration: Twelve months (Dec 2020-Dec 2021) Method: Rotterdam criteria was used to diagnose PCOS. WHO criteria of BMI=23 kg/m² cutoffs for Asian population was used to divide women in two groups; non-obese (Group-A < 23 kg/m²) and obese/overweight (Group-B ≥ 23 kg/m²). In both groups ovulation was induced with Clomiphene Citrate and response was assessed via ultrasound follicular tracking, Day 21 serum progesterone and serum B-HCG levels two weeks after the HCG injection. Results: Total participants were 200 (100 in each group). Mean age (years) in Group-A vs Group-B was 25.38 vs, 27.62 and mean BMI (kg/m²) was 20.82 vs 28.34 respectively. The frequent symptoms in Group-A Vs Group-B were Oligomenorrhoea (87% vs 97%) and amenorrhoea (13% vs 03%). P-value (0.009) was significant. Difference in Ultrasound features of PCOS and LH:FSH ratio in both groups were insignificant (P-value=0.214 and 0.316 respectively). The difference in almost all parameters of OI between the two groups was statistically significant. In Group-A vs Group-B; the presence of dominant follicle after Clomiphene citrate was 52% vs 34% (p value=0.01); Day 21 serum progesterone >30ng/ml was 21% vs 09% (p value=0.01); a positive serum β-HCG level >50 mIU/L 02 weeks after HCG administration was 12% vs 04% (p value=0.09). Conclusion: Obesity control and lifestyle modification are imperative for significant improvement in fertility outcomes for PCOS related subfertility.