Improved responsiveness of PCOS patients to clomiphene after CYP17a inhibitor.
OBJECTIVE
To study the effect of CYP17a inhibitor, "ketoconazole," on clomiphene responsiveness in PCOS patients.


METHODS
Prospective analysis was employed with the setup at Alexandria IVF/ICSI center. Ninety-seven insulin-resistant PCOS patients undergoing ovulation induction using clomiphene citrate were randomly divided, by random number table, into two groups. The first group (n = 49) received ketoconazole (400 mg daily) till correction of metabolic syndrome followed by clomiphene (100 mg/day); the second group (n = 48) receiving clomiphene without ketoconazole pretreatment. Main outcome measures were incidence of clomiphene resistance, monofollicular response, fasting insulin/glucose ratio, serum testosterone, and pregnancy rates.


RESULTS
The ketoconazole group showed significantly (p < 0.05) higher incidence of monofollicular response (38%), higher pregnancy rates, and significantly less marked antiestrogenic manifestations than did the control group. They also had significantly lower incidence of clomiphene resistance (11.6%), lower serum testosterone levels, less hyperinsulinaemia, than did the control group.


CONCLUSIONS
Ketoconazole improved clomiphene responsivenss in PCOS patients and attenuated its untoward biological effects.
Ali Hassan
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Obstetrics and Gynecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. hassanali@dataxprs.com.eg
El-Gezeiry
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Nafaa
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TM
Baghdady
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I
D002996:Clomiphene / Q000008:administration & dosage*; D004965:Estrogen Antagonists / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D007654:Ketoconazole / Q000008:administration & dosage*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D013254:Steroid 17-alpha-Hydroxylase / Q000037:antagonists & inhibitors*; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
D004965:Estrogen Antagonists; D007328:Insulin; D002996:Clomiphene; D013739:Testosterone; D013254:Steroid 17-alpha-Hydroxylase; D007654:Ketoconazole