Insulin resistance in clomiphene responders and non-responders with polycystic ovarian disease and therapeutic effects of metformin. |
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Authors: | M E Parsanezhad S Alborzi A Zarei S Dehbashi G Omrani |
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Institution: | Department of Obstetrics and Gynecology, Division of Infertility and Endocrinology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. parsame@sums.ac.ir |
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Abstract: | OBJECTIVES: To evaluate the clinical features, endocrine and metabolic profiles in clomiphene (CC) responders and non-responders with polycystic ovarian disease (PCOD), and to examine the effects of metformin (MTF) on the above parameters of CC resistance. METHODS: A prospective clinical trial was undertaken at the infertility division of a university teaching hospital. Forty-one CC responders were selected and their hormonal and clinical features were determined. Forty-one CC-resistant PCOD women were also selected and clinical features; metabolic and hormonal profiles before and after treatment with MTF 1500 mg/day for 6-8 weeks were evaluated. Women who failed to conceive were treated by CC while continuing to take MTF. RESULTS: CC responders had higher insulin levels while non-responders were hyperinsulinemic. Menstrual irregularities improved in 30%. Mean+/-S.D. area under curve of insulin decreased from 297.58+/-191.33 to 206+/-0.1 mIU/ml per min (P=0.005). Only 39.39% ovulated and 24.24% conceived. CONCLUSION: PCOD is associated with insulin resistance (IR) particularly in CC-resistant women. Insulin resistance and androgen levels are significantly higher in obese patients. MTF therapy improved hyperandrogenemia, IR, and pregnancy rate. |
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