Clomiphene-resistant Polycystic Ovary Syndrome Research Articles

Does Coenzyme Q10 Improve Ovulation and Pregnancy Rates in Clomiphene Citrate-resistant Polycystic Ovary Syndrome?

Does Coenzyme Q10 Improve Ovulation and Pregnancy Rates in Clomiphene Citrate-resistant Polycystic Ovary Syndrome?

Effect of laparoscopic ovarian drilling on ovulation rate in women with clomiphene resistant polycystic ovarian syndrome

Effect of laparoscopic ovarian drilling on ovulation rate in women with clomiphene resistant polycystic ovarian syndrome

Clomiphene citrate (CC) plus L-Carnitine improves clinical pregnancy rate along with glycemic status and lipid profile in clomiphene-resistant polycystic ovary syndrome patients: A triple-blind randomized controlled clinical trial

Despite the high prevalence of polycystic ovary syndrome (PCOS), its pathogenesis has not been well understood. This study was designed to evaluate the reproductive and metabolic effects of L-carnitine in clomiphene citrate (CC)-resistant PCOS women. The triple-blind randomized controlled clinical trial was conducted in the infertility clinic of the Imam Hossein hospital and registered with registration number: IRCT20210415050980N1. A total of 148 CC-resistance PCOS women have randomly divided into two groups; group A received 150 mg/day CC from day 5 to day 9 of the ovulation cycle and 3 g oral L-carnitine, and Group B received 150 mg/day oral CC plus placebo. The primary outcome was the clinical pregnancy rate. The secondary outcomes were hormonal and metabolic profile changes. L-carnitine significantly improves ovulation and pregnancy rate (71.4% vs. 28.6%; p < 0.001 and 33% vs. 11%; p < 0.001). The number of stimulated follicles reaching˃17 mm diameter was significantly higher in Group A compared to Group B (2.14 ± 0.64 vs. 0.71 ± 0.7; p < 0.001). Endometrium was significantly thicker in Group A (8.14 ± 1.89 mm vs. 6.43 ± 1.3 mm; p < 0.001). L-carnitine treatment significantly decreased fasting serum glucose and Hb A1c (P > 0.001) and improved lipid profile. L-carnitine treatment may increase pregnancy rate along with improving the glycemic status and lipid profile. However, further studies are recommended to explore the exact mechanisms of L-carnitine role in patients with PCOS. • The number of stimulated follicles reaching˃17 mm diameter was significantly higher in Clomiphene citrate plus L-carnitine group compared to Clomiphene citrate plus placebo Group. • L-carnitine treatment significantly increased endometrium thickness. • L-carnitine treatment significantly decreased fasting serum glucose and Hb A1c as well as improved lipid profile. • L-carnitine significantly improve ovulation rate and pregnancy rate.

Comparing Effectiveness of Letrozole versus Postmenopausal FSH in Patients with Clomiphene Citrate-Resistant Polycystic Ovary Syndrome

Comparing Effectiveness of Letrozole versus Postmenopausal FSH in Patients with Clomiphene Citrate-Resistant Polycystic Ovary Syndrome

Effect of Administrating Coenzyme Q10 with Clomiphene Citrate on Ovulation Induction in Polycystic Ovary Syndrome Cases with Resistance to Clomiphene Citrate: A Randomized Controlled Trial.

The purpose of this study was to assess the effect of combining low dose of Coenzyme Q10 with clomiphene citrate on ovulation induction in polycystic ovary syndrome (PCOS) women with clomiphene resistance. A total of 149 women with clomiphene resistant PCOS who needed ovulation induction were randomly allocated to oral clomiphene citrate and Coenzyme Q10 group and oral clomiphene citrate only group using a computer generated allocation sequence. The study was conducted at Aziz Medical Center, Karachi, Pakistan from 1st July 2020 to 1st October 2020. Polycystic ovary syndrome was diagnosed according to Rotterdam criteria. The primary outcome was ovulation and conception rate per cycle. Chi square test and Fischer's exact test were used to compare these variables at p<0.05 level of significance. Of the 133 women assessed, the proportion of women who ovulated with combination (70% vs., 19%, p=0.001) was greater and the combination group had greater conception rate per cycle than those who received only clomiphene (48.6% vs. 6.3%, p<0.001). When stratified according to obesity, 85.3% of non-obese women who received combination ovulated whereas only 55.6% of obese women ovulated (p=0.002). Moreover, 48.6% of non-obese women conceived in the combination group as compared to 6.3% of obese women (p=0.007). Women who received combination were six times more likely to conceive than women who only received clomiphene citrate (AOR=6.344, 95% CI: 1.452-27.71, p=0.014). Coenzyme Q10 is a valuable adjunct in women with PCOS undergoing ovulation induction. It improves ovulation and conception in women with clomiphene resistance.

Correlation of serum leptin and ghrelin levels with endocrine and reproductive parameters in women with clomiphene citrate resistant polycystic ovary syndrome.

Objective:To investigate the changes in serum ghrelin and leptin levels in patients with clomiphene-resistant polycystic ovary syndrome (PCOS).Materials and Methods:Thirty-five patients who could not achieve ovulation or pregnancy despite using 150 mg/day of clomiphene citrate (CC) participated in the study. Thirty-five patients who were compatible with the study group in terms of age and body mass index (BMI) but did not have clinical and laboratory findings of PCOS constituted the control group. On the third day of the cycle, in addition to the basal hormone profile, ghrelin and leptin levels were also measured. Patients in both groups went to IVF/ICSI. Basal hormone values, leptin, ghrelin, metabolic, demographic parameters, and clinical pregnancy rates were correlated.Results:Patients in both groups were recorded to be similar in terms of age (29.4±0.11 vs 28.5±7.30), BMI (24.3±3.07 vs 23.8±1.55), and infertility time (6.14±4.30 vs 6.03±1.28). Serum ghrelin levels of the PCOS group were significantly lower than the control group (0.48±2.21 vs 1.19±4.02) Serum leptin levels of the PCOS group were significantly higher than the control patients (45.6±304 vs 16.5±0.32). Serum leptin levels and BMI (r=0.65, p<0.01) A positive correlation was found between luteinizing hormone (LH) (r=0.53, p<0.02), and insulin resistance (r=0.74, p<0.03). There was a negative (r=-0.76, p<0.03) correlation between serum ghrelin and LH. A positive and significant correlation was found between serum ghrelin, testosterone, mature oocyte, and implantation rates.Conclusion:Serum ghrelin correlates with fertility outcomes in women with CC-resistant PCOS undergoing IVF/ICSI.

Ovarian drilling down-regulates endometrial nuclear factor-κB p65 expression in women with PCOS: A prospective case-control study

Objective:To investigate the impact of laparoscopic ovarian drilling (LOD) on the expression of endometrial NFκB p65 (Rel A) in women with clomiphene-resistant polycystic ovary syndrome (PCOS).Materials and Methods:The study group comprised 25 normal-weight women with PCOS undergoing LOD and 14 control women without PCOS. Endometrial NF-κB p65 levels evaluated before and after LOD following immunohistochemical staining. The semiquantitative method was used to evaluate the intensity of NF-κB p65 levels. NF-κB p65 was found to higher in the endometrium of patients with PCOS compared to controls. LOD leads to significant down-regulation in endometrial NF-κB p65 expression. NF-κB p65 expression of PCOS and fertile control were similar after LOD. After LOD, H-score values decreased approximately 3-fold. The H-score of the control subjects was lower than the preoperative and postoperative H-score values of the control women with ovarian cyst.Results:Expression of endometrial NF-κB p65 did not change following ovarian cystectomy. The laterality of the ovarian cyst did not cause any change in preoperative H-score values.Conclusion:By downregulating the endometrial NF-κB p65 expression LOD improved physiological inflammation in women with PCOS.

Impact of mechanical endometrial injury on clinical pregnancy rates in women with clomiphene-resistant polycystic ovary syndrome

Impact of mechanical endometrial injury on clinical pregnancy rates in women with clomiphene-resistant polycystic ovary syndrome

Ultrasound-guided transvaginal ovarian needle drilling for clomiphene-resistant polycystic ovarian syndrome in subfertile women.

Ovulatory disturbance is a key diagnostic feature of polycystic ovarian syndrome (PCOS), leading to infertility and correspondingly heavy disease burden. Many therapeutic strategies have been used to induce ovulation for women with PCOS who are infertile. Ultrasound-guided transvaginal ovarian needle drilling (UTND) is a novel surgical method used to induce ovulation for women with clomiphene-resistant PCOS at the outpatient clinic. OBJECTIVES: To evaluate the efficacy and safety of UTND for subfertile women with clomiphene-resistant PCOS. We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, and other databases to December 2020. We checked conference abstracts, reference lists, and clinical trials registries. We also contacted experts and specialists in the field for any additional trials . We planned to include randomised controlled trials comparing UTND to laparoscopic ovarian drilling, and UTND combined with gonadotropins to gonadotropins, in women of reproductive age with clomiphene-resistant PCOS and infertility. Two review authors independently screened the trials identified by the search for inclusion, assessed methodological quality and risk of bias, and extracted data. The primary outcomes were live birth rate and incidence of surgical complications (bleeding and infection). Secondary outcomes included pregnancy rate, ovulation rate, and ovarian hyperstimulation syndrome. We planned to calculate odds ratios with 95% confidence intervals for dichotomous data. We would assess overall quality of the evidence by applying the GRADE criteria. We did not identify any trials for inclusion in the review. We were unable to assess the benefit or harm of applying UTND for women with clomiphene-resistant PCOS, as no studies could be included in the current review. We moved the previously included trials to studies awaiting classification due to concerns regarding methodology. Since we did not identify any studies for inclusion, we were unable to assess the benefit or harm of applying UTND for women with clomiphene-resistant PCOS.

Extended Letrozole Regimen for Treatment of Clomiphene Resistant Polycystic Ovary Syndrome Patients

Extended Letrozole Regimen for Treatment of Clomiphene Resistant Polycystic Ovary Syndrome Patients

Therapeutic Effect of Vitamin D3 Supplementation to Clomiphene Citrate Resistant PCOS Women: A Randomized Controlled Trial

Abstract Background Polycystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders affecting females in their reproductive age. In PCOS, an imbalance between androgens, anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH), cause a halt of follicular growth. Insulin resistance (IR) is another important component of PCOS. There is increasing evidence that vitamin D affects insulin and glucose metabolism, Vitamin D plays a vital role in the regulation of glucose-insulin homeostasis. Objectives to assess the efficacy of vitamin D supplementation in improving ovulation induction in PCOS women (1ry outcome) and increasing pregnancy rate (secondary outcome). Patients and Methods 120 women diagnosed PCOS according to Rotterdam criteria and were resistant to CC treatment were randomly allocated into equal two groups: Group V: number of 60 patients received cholecalciferol + Metformin for 2 months. Group C: 60 patients received Metformin 2 months. After two months from the start:Both study groups started induction with Clomiphene Citrate added every month starting from the 3rd month to the 5th month (3 cycles of ovulation induction) in addition to previous drugs mentioned. Results In our study results, regulation of menstrual cycle occured in 63.6% of women who recieved vitamin D + metformin (group V) and ovulation was confirmed in 34.5% of the total number (55 women). Later, 18% of them got pregnant after 3 months of treatment. Added to that 16 women out of 39 (41%) got pregnant by the end of the follow up period with cumulative pregnancy rate (53%). On the other hand menstrual regularity in (group C: metformin) recorded 61% with ovulation percentage of 26.9% (n = 54). Followed by 14.8% pregnancy rate at the 3rd month., which increased to 27.5% by the end of the study out of 47.5% ovulated women (n = 40). Cumulative pregnancy rate 40%. Conclusion From the current study we can conclude that there is no significant difference of adding vitamin D to CC resistant PCOS regarding ovulation and pregnancy rates. However, it can augment metformin action and improves its outcome.

Effect of Ubiquinol supplementation on ovulation induction in Clomiphene Citrate resistance

BackgroundClomiphene Citrate is considered the gold-standard for induction of ovulation and has been used for several years to treat PCOS related infertility. Unfortunately, 15-40% of women with PCOS are resistant to Clomiphene Citrate. The study aimed to evaluate potential benefits of adding the active form of Coenzyme Q10 (Ubiquinol) to Clomiphene Citrate compared with Human Menopausal Gonadotropins (hMG) in Clomiphene Citrate resistant PCOS patients. 148 PCOS Patients with Clomiphene Citrate resistance were randomized into two groups (A and B). In group A, controlled ovarian stimulation was done by Clomiphene Citrate 150 mg daily (from 2nd till 6th day of cycle) together with Ubiquinol starting from 2nd day till day of hCG triggering in a dose of 100 mg orally once daily. In group B, hMG was given from 2nd day of the cycle in a dose ranging from 75 to 225 IU. Serial transvaginal ultrasonography was done starting on cycle day 8 and continued till size of leading follicle reaches 18 mm or more then ovulation triggering was done. Thereafter, patients were advised for a timed intercourse (TI) after 36 hours. A blood sample was withdrawn seven days after hCG triggering, for measurement of serum progesterone. If the Patient presented with a missed period for one week, a serum sample was sent for β-hCG.ResultsThere were no statistically significant differences (P > 0.05) between studied groups regarding; number of cases reaching mature follicular size, number of stimulated cycles, endometrial thickness on the day of hCG triggering, mid-luteal serum progesterone, positive serum pregnancy test and clinical pregnancy rate.ConclusionsAddition of Ubiquinol to Clomiphene Citrate improved ovarian responsiveness in Clomiphene Citrate resistant patients with results comparable to conventional hMG stimulation protocol.

Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections.

The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene-resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene-resistant PCOS.

Correlation between serum carnitine level and Soluble Receptors for Advance Glycation End Products(sRAGE) in Clomiphene Citrate Resistant- PCOS Women

The most frequently diagnosed condition in women at the age of reproduction is the polycystic ovarian syndrome (PCOS).it could be related to a complex endocrine condition, due to its heterogeneity and uncertainty about its etiology, as the clinical highlights of PCOS incorporate those related to reproductive signs such as decreased frequency of ovulation, irregular menstrual cycles, decreased fertility. Carnitine plays a substantial role in weight loss, glucose tolerance, insulin function and fatty acid metabolism. Thus carnitine plays a crucial role in controlling obesity, insulin resistance, oxidative stress that are associated with PCOS .While, AGEs are a diverse group of reactive molecules that are formed endogenously by non-enzymatic reactions of carbonyl group of carbohydrates with free amino groups of proteins, nucleic acids or lipids. The soluble form of receptors of AGE (sRAGE) could play an important role in management obesity, insulin resistance, hyperandrogenism, oxidative stress which could be related to PCOS. This study was aimed to investigate serum levels of carnitine &amp; soluble receptors for advanced glycation end products (sRAGE) in clomiphene resistant PCOS .Besides assessing the correlation between serum levels of carnitine ,as well as, soluble receptors of AGE with hormonal ( LH, FSH&amp; Testosterone) and metabolic ( serum glucose , serum insulin &amp; HOMA-IR) markers in these patients .&#x0D; The study included thirty women with clomiphene resistant PCOS and thirty apparently healthy women, as a control .In order to measure serum total carnitine and serum soluble receptor of advance glycation end product (sRAGE in PCOS and control groups.&#x0D; The results of our study have shown a decreased serum levels of total carnitine in PCOS group in comparison with control group (48.05 and 59.73 nmol/ml, respectively), but there was no significant elevation in serum levels of sRAGE in patients group as compared with control group .In addition to a significant correlation between serum total carnitine and serum sRAGE levels (r=0.45, P-value=0.03). &#x0D; In conclusion serum total carnitine level was low in Clomiphene resistant-PCOS patients in comparison with control group. Although, sRAGE levels in clomiphene resistant- PCOS patients were not significantly different from the age and BMI-matching controls, but a significant correlation between serum total carnitine and sRAGE was detected.&#x0D; Key words: Poly cystic ovarian syndrome, soluble receptor of advance glycation end products (sRAGE) , SerumTotal Carnitine

Impact of Cyproterone Acetate and Ethinylestradiol on Clomiphene Resistant PCOS Patient with High Serum AMH level

Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. PCOS is characterized by hyperandrogenism and oligomenorrhea, and Polycystic ovary .It is a common cause of female subfertility. Anti-mullerianhormone (AMH) is 2-4 times higher in patients with PCOS compared to normal subfertilety patient.&#x0D; Objective: To assess the impact of metformin and oral contraceptives (OCs) containing cyproterone acetate and ethinyl estradiol on serum anti-Mullerian hormone (AMH) levels, with CC resistant polycystic ovary syndrome (PCOS)&#x0D; Methods: This prospective randomized controlled trial was conducted at Bangabandhu Sheikh Mujib Medical University(BSMMU), Dhaka during the preoid of January 2019 to june 2019. Already diagnosed patients of polycystic ovary syndrome with subfertility with high serum AMH level more than 5 ng/ml attending in the OPD of Reproductive Endocrinology and infertility department at BSMMU are the study population. Total 60 subjects fulfilling rotardum criteria and who are treated with 3 cycle CC with 100mg /day for 5 days from day 2 of menstrual cycle but fail to ovulate were recruited for the current study. Those subjects with tubal, and male factors excluded from the study. .After enrollment of the patients, randomization will be carried out by blocked randomization method to divide them equally into two groups-Group A number of patients 30 ( treated with2mg cyproterone acetate (CPA) and 35 mcg of ethinylestradiol (EE) and Group B number of patients 30 treated with Metformin). Group A patients will receive treatment with 2mg cyproterone acetate (CPA) and 35 mcg of ethinylestradiol (EE) for 6 months and Group B patients will receive treatment with Metformin for 6 months . After enrollment of the patients, base line hormonal assessment basal level of FSH, LH ,thyroid-stimulating hormone (TSH), prolactin (PRL), and testosterone hormones were registered and metabolic assessment included OGTT and fasting insulin level were done, and to identify the changes in clinical and biochemical profile of study population. Clinical evaluation, by history and examination, transvaginal ultrasonography of both group and changes of the above mentioned parameters of both group were recorded after 6 month of completion of treatment.&#x0D; Results: A Changes in clinical parameters (Acne, BMI, Menestrual cycle) was recorded every three monthly for 6 month. Changes of biochemical parameters (serum LH (D2), serum FSH (D2), serum testosterone, OGTT and fasting insulin), serum AMH were recorded every three monthly for 6 month. Changes of sonographic parameters (ovarian volume, Antral follicular count development, was done monthly for 6 cycles. AMH levels are significantly reduced under treatment with OCP containing 35mg ethinylestradiol plus 2 mg cyproteroneacetate than metformin. AMH was significantly decreased after treatment with 35 mg ethinylestradiol plus 2 mg cyproterone acetate ( p &lt; 0.001 at 6 months). and treatment with metformin did not significantly affect serum AMH levels. AMH was significantly decreased after treatment with metformin (p &lt; 0.005). Serum LH was and OGTT was significantly decreased in both treatment p&lt;0.001.&#x0D; Conclusion(s:) AMH serum levels were significantly decreased under treatment with 35mg ethinylestradiol plus 2mg cyproterone acetate, due to decrease in androgens and suppression of gonadotropins(LH).&#x0D; J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 38-44

Reduced Angiopoietin-2 as a Predictive Biomarker for Clomiphene Citrate Resistance in Polycystic Ovary Syndrome.

Background:Even though angiopoeitin-2 and interleukin (IL)-23 are known to be altered in polycystic ovary syndrome (PCOS), their association with clomiphene citrate (CC) resistance has not been studied.Aim:The objective of the study was to investigate whether angiopoietin-2 levels are associated with inflammation and CC resistance in PCOS.Settings and Design:This study was conducted in a tertiary care hospital.Materials and Methods:Eighty-one women diagnosed with PCOS and on treatment with CC were enrolled in the study. Angiopoeitin-2 and IL -23 were analyzed in all the subjects.Results:Angiopoietin-2 was significantly reduced (P = 0.018), and body mass index (BMI) (P = 0.049) and duration of infertility (0.006) were significantly increased in PCOS women with CC resistance compared to those who are sensitive to CC. In CC resistant PCOS, IL-23 predicts reduction in angiopoietin-2 levels (P = 0.010). Among angiopoietin-2, IL-23, BMI, and duration of infertility, we found that angiopoeitn-2 (P = 0.020) and duration of infertility (0.036) can predict resistance to CC therapy among PCOS subjects.Conclusion:We conclude that reduced angiopoietin-2 levels predict CC resistance in women with PCOS.

A randomized controlled trial of combination of letrozole and clomiphene citrate or letrozole alone for induction of ovulation in women with clomiphene citrate-resistant polycystic ovary syndrome attending infertility centre

A randomized controlled trial of combination of letrozole and clomiphene citrate or letrozole alone for induction of ovulation in women with clomiphene citrate-resistant polycystic ovary syndrome attending infertility centre

Rosiglitazon Meleat’ın Klomifen Sitrata Dirençli Polikistik Over Sendromlu İnfertil Olgularda Tek Başına veya Klomifen Sitratla Kombine Kullanımının Karşılaştırılması

INTRODUCTION: Most of the obese PCOS patients are resistant to clomiphene citrate standard doses. In these cases metabolic syndromes are treated by using insulin sensitizing drugs so that ovulation can be achieved.In this study rosiglitazine maleat was used in order to induce ovulation in obese clomiphene resistant PCOS patients. METHODS: 30 women(18-40 year old) with clomiphene resistant polycystic ovary syndrome that were obese (BMI&gt;25 kg/m2) and hyperinsulinemic were seperated in two groups. In the first group (n=15) oral antidiabetic Rosiglitazone maleate( 4mg bid) which belongs to thiazolidinediones were used.In the second group(n=15) in addition to clomiphen citrate(50 bid)and Rosiglitazone maleate(4 mg bid) were used, ovulation and pregnancy rates were compared. In both groups ovulation and pregnancy were recorded, in the second group ovulation and pregnancy rates were higher than the first group but these rates were not significant. RESULTS: In group 1, ovulation was achieved in 5 patients (%33) and pregnancy was achieved in 1 patient (%7). In group 2, ovulation was achieved in 9 patients (%60) and pregnancy was achieved in 3 patients (%20).There was no statistical significance between two groups. DISCUSSION AND CONCLUSION: In our study in obese and hyperinsulinemic patients rosiglitazone maleat can induce ovulation and in addition to clomiphene citrate also ovulation can be achieved although it is statistical insignificant. As a result Rosiglitazone maleate can be used alternatively as an insulin sensitizer and ovulation induction agent.

Extended Use of Clomiphene Citrate in Induction of Ovulation in Polycystic Ovary Syndrome with Clomiphene Citrate Resistance

Background: Clomiphene citrate (CC) is still holding its place as the first-line treatment for induction of ovulation in polycystic ovary syndrome (PCOS) patients. Objective: to assess the effect of extended clomiphene citrate on pregnancy outcomes of clomiphene resistant PCOS. Patients and methods: this study was conducted on 48 PCO patients with CC resistance attended to the Obstetrics and Gynecology Outpatient Clinic at Menoufia University and Al-Bajour General Hospitals, from April 2018 to February 2020. Patients were treated with an extended CC administration (150 mg for 10 days) to overcome anovulation. Result: There was highly significant change in follicle-stimulating hormone (FSH), luteinizing hormone (LH) and FSH/LH after extended CC treatment (p < 0.001). Also, serum progesterone and number of follicles were significantly increased after treatment compared to before treatment. Conclusion: CC extended is a safe, effective with minimal side effect, but low pregnancy rate was observed. Therefore, further studies with large number of PCO patients with CC resistant with addition of other drugs are required to investigate the improvement of the pregnancy rate.

Extended Use of Clomiphene Citrate in Induction of Ovulation in Polycystic Ovary Syndrome with Clomiphene Citrate Resistance

Background: Clomiphene citrate (CC) is still holding its place as the first-line treatment for induction of ovulation in polycystic ovary syndrome (PCOS) patients. Objective: to assess the effect of extended clomiphene citrate on pregnancy outcomes of clomiphene resistant PCOS. Patients and methods: this study was conducted on 48 PCO patients with CC resistance attended to the Obstetrics and Gynecology Outpatient Clinic at Menoufia University and Al-Bajour General Hospitals, from April 2018 to February 2020. Patients were treated with an extended CC administration (150 mg for 10 days) to overcome anovulation. Result: There was highly significant change in follicle-stimulating hormone (FSH), luteinizing hormone (LH) and FSH/LH after extended CC treatment (p < 0.001). Also, serum progesterone and number of follicles were significantly increased after treatment compared to before treatment. Conclusion: CC extended is a safe, effective with minimal side effect, but low pregnancy rate was observed. Therefore, further studies with large number of PCO patients with CC resistant with addition of other drugs are required to investigate the improvement of the pregnancy rate.