title: Naltrexone treatment in clomiphene resistant women with polycystic ovary syndrome.
abstract: BACKGROUND
  Endogenous opiates may affect various aspects of reproductive and metabolic function in patients with polycystic ovary syndrome (PCOS). This study evaluated long-term inhibition of the opioid system using naltrexone in clomiphene citrate (CC)-resistant women with PCOS.
  
  
  METHODS
  A group of 30 infertile females with PCOS were evaluated; all subjects were obese, hyperandrogenic and hyperinsulinemic; 16 patients were amenorrhic and 14 were oligomenorrhic. All subjects received natrexone (50 mg p.o. daily) for 6 months. Patients who did not ovulate after 12 weeks of naltrexone monotherapy, also received CC (starting at 50 mg/day for 5 days and, for non-responders, increasing it up to 150 mg/day).
  
  
  RESULTS
  Of the 30 women, 3 ovulated during naltrexone monotherapy and 19 of the remaining 27 ovulated during naltrexone + CC therapy. There were no conceptions during naltrexone monotherapy, but 9 of 27 women (33.3%) conceived during naltrexone + CC; there was one missed abortion at 9 weeks, one preterm delivery at 34 weeks and seven term live births. Naltrexone therapy was also followed by significant reductions in BMI, fasting serum insulin, luteinizing hormone (LH), LH/follicle-stimulating hormone ratio and testosterone.
  
  
  CONCLUSIONS
  In this preliminary trial, naltrexone improved endocrine and metabolic function in women with CC-resistant PCOS. Furthermore, naltrexone restored CC sensitivity in the majority of subjects, resulting in a significant number of pregnancies.
authors.affiliation: Department of Obstetrics and Gynecology, Benha School of Medicine, Benha, Egypt.
authors.forename: M I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: A J
authors.initials: AJ
authors.lastname: Duleba
authors.forename: O
authors.initials: O
authors.lastname: El Shahat
authors.forename: M E
authors.initials: ME
authors.lastname: Ibrahim
authors.forename: A
authors.initials: A
authors.lastname: Salem
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000378:metabolism; D015992:Body Mass Index; D002996:Clomiphene / Q000494:pharmacology*; D004351:Drug Resistance; D004965:Estrogen Antagonists / Q000494:pharmacology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy; D007986:Luteinizing Hormone / Q000378:metabolism; D009271:Naltrexone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D018873:Pregnancy Rate
chemical_list: D000701:Analgesics, Opioid; D004965:Estrogen Antagonists; D009292:Narcotic Antagonists; D002996:Clomiphene; D009271:Naltrexone; D007986:Luteinizing Hormone