Serum insulin in clomiphene responders and nonresponders with polycystic ovarian disease.
OBJECTIVE
To investigate insulin levels in women with polycystic ovarian disease (PCOD) who are responders or nonresponders to clomiphene citrate (CC).


METHODS
Open and prospective study.


METHODS
Outpatient infertility clinic of a third level medical institution.


METHODS
Ten healthy women (group 1) and 35 PCOD women classified as responders (group 2 n = 10) or nonresponders (group 3 n = 25) on the basis of serum progesterone > or = 19 nmol/L in response to CC repeatedly administered in doses up to 250 mg/day for five days; they were further subdivided if body mass index (BMI) was below (N) or above (H) mean + 3 SD of group 1.


METHODS
Blood samples were obtained in a 100-g, 2-hours oral glucose tolerance test (OGTT).


METHODS
Serum glucose, insulin, free testosterone (free-T), dehydroepiandrosterone sulphate (DHEA-S), and androstenedione (A) were determined in the samples OGTT and the areas under the curve (AUC) were calculated.


RESULTS
Group 3 had higher BMI, basal LH, and insulin and AUC insulin than groups 1 and 2; free-T was higher in groups 2 and 3 than in group 1, and basal PRL was higher in group 2 compared to groups 1 and 3. When BMI < or = 25.4 kg/m2 (mean + 1 SD of group 1) 77% of the PCOD cases responded (10 out of 13) whereas none with BMI > 25.4 responded to CC (n = 22) irrespectively of basal insulin concentration or AUC insulin.


CONCLUSIONS
Moderate to excessive overweight seems more frequently and closely associated to a negative CC response in women with PCOD than hyperinsulinemia.
Espinosa de los Monteros
A
A
Endocrine Department, Instituto Nacional de Perinatología, Mexico City, Mexico, D.F.
Ayala
J
J
Sanabria
L C
LC
Parra
A
A
D000328:Adult; D015992:Body Mass Index; D002996:Clomiphene / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005951:Glucose Tolerance Test; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D007328:Insulin / Q000097:blood*; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000150:complications; D011446:Prospective Studies
D005300:Fertility Agents, Female; D007328:Insulin; D002996:Clomiphene