[Insulin sensitivity in patients not responding to ovulation induction using clomiphene citrate].
BACKGROUND
The role of insulin resistance (IR) of infertile patients with chronic anovulation in their therapeutic failure to clomiphene citrate (CC) is not quite clear.


OBJECTIVE
Determine the sensitivity to insulin in patients with chronic anovulation and failure to the treatment with clomiphene citrate.


METHODS
A cross-sectional clinical study in infertile patients with clomiphene citrate resistance and in patients with adequate response to clomiphene citrate was carried out. In all patients insulin resistance was determined by the rate of glucose/insulin, HOMA (Homestatic Model Assessment) and the insulin sensitivity test. For the inferential statistical analysis, a Student's t test for independent samples was used.


RESULTS
The average total basal insulin was 19.6 +/- 8.1 microU/mL. We observed higher concentrations in the clomiphene citrate resistance group (22.1 +/- 8.9 vs. 15.8 +/- 5.1 mU/mL p = 0.07). The glucose/insulin rate was statistically minor in patients with resistance to clomiphene citrate (4.2 +/- 1.9 versus 6.9 +/- 2.1 p = 0.02), but HOMA was not significantly different in both groups (4.3 +/- 1.4 vs. 3.9 +/- 1.3 p = 0.6). The total rate of glucose disappearance (KIIT) was 4.1 +/- 1.2. However, the statistical analysis did not show significant statistical differences between the two groups.


CONCLUSIONS
Our preliminary results suggest that insulin resistance can be a mechanism involved in the pharmacologic response to ovulation induction in infertile patients, but coexisting pathophysiological mechanisms such as hyperandrogenism might also account for the lack of response to clomiphene citrate.
Unidad Médica de Alta Especialidad Dr. Victor Manuel Espinoza de los Reyes Sánchez, Hospital de Ginecoobstetricia 3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, DF México. victor.vital@imss.gob.mx
Víctor Saúl
VS
Vital Reyes
Sergio
S
Téllez Velasco
Brendha
B
Ríos Castillo
Manuel
M
Badillo Buenfil
Juan Carlos
JC
Hinojosa Cruz
D000328:Adult; D000858:Anovulation / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism*; D002996:Clomiphene / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D007333:Insulin Resistance; D010062:Ovulation Induction; D017211:Treatment Failure
D005300:Fertility Agents, Female; D002996:Clomiphene