Insulin resistance in clomiphene responders and non-responders with polycystic ovarian disease and therapeutic effects of metformin.
OBJECTIVE
To evaluate the clinical features, endocrine and metabolic profiles in clomiphene (CC) responders and non-responders with polycystic ovarian disease (PCOD), and to examine the effects of metformin (MTF) on the above parameters of CC resistance.


METHODS
A prospective clinical trial was undertaken at the infertility division of a university teaching hospital. Forty-one CC responders were selected and their hormonal and clinical features were determined. Forty-one CC-resistant PCOD women were also selected and clinical features; metabolic and hormonal profiles before and after treatment with MTF 1500 mg/day for 6-8 weeks were evaluated. Women who failed to conceive were treated by CC while continuing to take MTF.


RESULTS
CC responders had higher insulin levels while non-responders were hyperinsulinemic. Menstrual irregularities improved in 30%. Mean+/-S.D. area under curve of insulin decreased from 297.58+/-191.33 to 206+/-0.1 mIU/ml per min (P=0.005). Only 39.39% ovulated and 24.24% conceived.


CONCLUSIONS
PCOD is associated with insulin resistance (IR) particularly in CC-resistant women. Insulin resistance and androgen levels are significantly higher in obese patients. MTF therapy improved hyperandrogenemia, IR, and pregnancy rate.
Parsanezhad
M E
ME
Department of Obstetrics and Gynecology, Division of Infertility and Endocrinology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. parsame@sums.ac.ir
Alborzi
S
S
Zarei
A
A
Dehbashi
S
S
Omrani
G
G
D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000187:drug effects; D015992:Body Mass Index; D002996:Clomiphene / Q000378:metabolism* / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000378:metabolism* / Q000627:therapeutic use*; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000378:metabolism; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008687:Metformin / Q000378:metabolism* / Q000627:therapeutic use*; D009765:Obesity / Q000378:metabolism; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000378:metabolism*; D011446:Prospective Studies; D012044:Regression Analysis
D001786:Blood Glucose; D005300:Fertility Agents, Female; D012739:Gonadal Steroid Hormones; D007328:Insulin; D002996:Clomiphene; D008687:Metformin