Abstract
Background: Clomiphene responsiveness has been varied in WHO group II anovulatory patients. Our study evaluates factors associated with clomiphene citrate responsiveness in this population. Various parameters were studied, including anthropometric, hormonal and transvaginal ultrasonographic measurements. Methods: A retrospective case-control study was done over a period of three years. A total of 260 women with WHO group II anovulatory related infertility treated with clomiphene citrate 100 mg/d for five consecutive days were enrolled. 173 women were categorized in clomiphene citrate resonsive group (CCR), defined as patients with at least one dominant follicle ≥17 mm or at least 2 dominant follicles ≥15 mm. 87 women were categorized in the non-ovulatory group (NCCR), defined as patients who not meet the responsive group criteria. Various clinical, metabolic, hormonal and ultrasound features were compared between two groups. Logistic regression analysis was used to analyze the significant factors. Results: Among all participants, the mean age was 32.6 ± 4.0 years. The mean body mass index in CCR and NCCR group was 23.9 ± 10.7 kg/m2 and 24.0 ± 4.0 kg/m2, respectively. The mean waist-hip ratio (WHR) of the NCCR group was higher than that of the CCR group, i.e., 0.83 ± 0.06 vs 0.81 ± 0.05 (p = 0.004). The waist-hip ratio was the most sensitive anthropometric predictor of non-responsiveness to clomiphene: cut-off value of 0.775 (90.8% sensitivity and 20.2% specificity) and cut-off value of 0.805 (73.6% sensitivity and 42.2% specificity). Age, clinical hyperandrogenism, polycystic ovarian morphology, low antral follicle count (≤5 follicles), baseline follicle-stimulating hormones and estradiol levels were not significantly different. Conclusions: The waist-hip ratio is a clinically useful parameter in predicting clomiphene responsiveness in normogonadotropic anovulatory women (WHO group II anovulation).
Highlights
Clomiphene responsiveness has been varied in World Health Organization (WHO) group II anovulatory patients
A total of 260 infertile women with normogonadotropic anovulation (WHO group II anovulation) who received Clomiphene citrate (CC) as an ovulation induction were enrolled in this study
The only difference of statical significance was that waist-hip ratio (WHR) of Clomiphene non-responsive group or anovulatory group (NCCR) was greater than that of clomiphene citrate resonsive group (CCR) group
Summary
Clomiphene responsiveness has been varied in WHO group II anovulatory patients. Our study evaluates factors associated with clomiphene citrate responsiveness in this population. Conclusions: The waist-hip ratio is a clinically useful parameter in predicting clomiphene responsiveness in normogonadotropic anovulatory women (WHO group II anovulation). As a selective estrogen-receptor modulator, clomiphene citrate reduces sex steroidal negative feedback at the hypothalamicpituitary axis, thereby enhancing secretion of folliclestimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland. This action, which stimulates the growth of the ovarian follicle and selection of dominant follicle and initiates ovulation, is initiated within the first five days of menstrual cycle under the theorical basis that physiologic lower levels of FSH permit dominant follicle selection [8]. Evidence suggests that CC was 1.35 to 20 times more likely to trigger ovulation compared to placebo [5]
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