title: Predictors of patient responses to ovulation induction with clomiphene citrate in patients with polycystic ovary syndrome experiencing infertility.
abstract: OBJECTIVE
  To identify predictors of clomiphene citrate-induced ovulation in patients with polycystic ovary syndrome (PCOS).
  
  
  METHODS
  A prospective observational study of patients 18-40 years of age with PCOS experiencing infertility was conducted at Menoufia University Hospital between January 2011 and January 2013. A range of potential predictors of ovulation were recorded before patients received a 50-mg dose of clomiphene citrate. Following ovulation or no response to increasing clomiphene-citrate doses, correlations between predictors and treatment responses were analyzed.
  
  
  RESULTS
  In total, 150 patients with PCOS experiencing infertility were enrolled. Following treatment, 110 (73.3%) patients ovulated. Highly significant differences were observed between treatment responders and non-responders in baseline amenorrhea, body mass index (BMI), waist circumference, total testosterone, anti-Müllerian hormone, fasting insulin, homeostatic model assessment of insulin resistance, and visceral fat area (P<0.001). Significant differences in mean ovarian volume (P<0.009) and ovarian stromal artery pulsatility index (P<0.003) were also observed. Total testosterone was the best individual predictor of clomiphene citrate treatment response. The area under the receiver operating characteristic curve in a multivariate prediction model was 0.98.
  
  
  CONCLUSIONS
  A combination of patient amenorrhea, BMI, total testosterone, anti-Müllerian hormone, ovarian volume, ovarian stromal artery pulsatility index, and visceral fat area could be used to predict clomiphene-citrate treatment response in patients with PCOS experiencing infertility. ClinicalTrials.gov: NCT02269306.
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt. Electronic address: drhamedellakwa@yahoo.com.
authors: Hamed E
authors: HE
authors: Ellakwa
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
authors: Zakaria F
authors: ZF
authors: Sanad
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
authors: Haitham A
authors: HA
authors: Hamza
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
authors: Mohamed A
authors: MA
authors: Emara
authors: Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
authors: Mohamed A
authors: MA
authors: Elsayed
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D054304:Anti-Mullerian Hormone / Q000097:blood; D002996:Clomiphene / Q000008:administration & dosage*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D006785:Hospitals, University; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D007333:Insulin Resistance; D010060:Ovulation / Q000187:drug effects; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications*; D011446:Prospective Studies; D013739:Testosterone / Q000097:blood; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D013739:Testosterone; D054304:Anti-Mullerian Hormone
keywords: AMH; Clomiphene citrate; HOMA-IR; PCOS; Visceral fat area