title: Improved responsiveness of PCOS patients to clomiphene after CYP17a inhibitor.
abstract: 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.
authors.affiliation: Obstetrics and Gynecology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt. hassanali@dataxprs.com.eg
authors.forename: H
authors.initials: H
authors.lastname: Ali Hassan
authors.forename: D
authors.initials: D
authors.lastname: El-Gezeiry
authors.forename: T M
authors.initials: TM
authors.lastname: Nafaa
authors.forename: I
authors.initials: I
authors.lastname: Baghdady
mesh_terms: 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
chemical_list: D004965:Estrogen Antagonists; D007328:Insulin; D002996:Clomiphene; D013739:Testosterone; D013254:Steroid 17-alpha-Hydroxylase; D007654:Ketoconazole