Clinical, ultrasonographic and endocrine predictors of ovarian response to clomiphene citrate in normogonadotropic anovulatory infertility

Objective: To identify screening characteristics involved in the prediction of anovulation after clomiphene citrate (CC) medication. Design: Prospective follow-up study Setting: Infertility Clinic, University Department of Obstetrics and Gynecology and Department of Medical Biochemistry, Faculty of Medicine, Alexandria. Materials and Methods: 60 patients presenting with oligomenorrhea or amenorrhea and infertility. Clinical, ultrasonographic and endocrine screening took place before initiation of CC medication. Endocrine screening included serum assays for LH, FSH, fasting insulin, glucose, leptin, inhibin B, testosterone and androstenedione. Results: 22 patients (36.6% of the total group) did not ovulate. Age, body mass index (BMI), ovarian volume, Doppler indices of ovarian stromal blood vessels, the LH/FSH ratio serum insulin, leptin, inhibin-B, testosterone and androstenedione differed significantly between CC responders and non-responders. However, forward stepwise multivariate analyses revealed a final prediction model for CC resistant anovulation including BMI, serum insulin and androstenedione. Conclusions: Data suggest that obesity, hyperinsulinaemia and hyper- androgenaemia are crucial factors involved in ovarian dysfunction that prevent response to CC.