Predictors of Rosiglitazone Success in Ovulation Induction among Women with Polycystic Ovary Syndrome Resistant to Clomiphene Citrate


Abstract:Background: In women suffering from polycystic ovary syndrome, correction of hyperinsulinemia results enhances spontaneous ovulation or alternatively, the responsiveness to ovulation induction agents such as clomiphene citrate.Objective: To study the effect of rosiglitazone on ovulation induction in obese, clomiphene citrate resistant women with polycystic ovarian syndrome.Design: Double –blind, randomized, placebo-controlled trial.Setting: Women with Polycystic ovarian syndrome attending as outpatients in Baghdad teaching hospital.Patient and methods: During the period from October 2010 to the end of December 2011, forty infertile women were diagnosed as having PCOS according to the Rotterdam criteria; all patients had previously received clomiphene citrate and were diagnosed as having resistance to this drug. Those patients were randomized into two treatment groups. Subjects in group 1(n=15) was randomized to receive rosiglitazone 4 mg/ day with a placebo on cycle days 5-9. Group 2 (n=25) was randomized to receive rosiglitazone 4 mg /day with clomiphene citrate on cycle days 5-9. The duration of the study was 3-6 months. The primary outcome was ovulation as defined by serum progesterone greater than 5 ng/dl at mid luteal phase of cycle. Secondary outcomes were pregnancy and changes in insulin sensitivity and androgens.Results: Overall, 24 of 40 (60%) women, who were previously resistant to clomiphene citrate, successfully ovulated. In subjects taking rosiglitazone alone (Group 1), 6 of 15 (40%) subjects ovulated compared with 18 of 25 (72%) women randomized to rosiglitazone with clomiphene citrate (Group2), three subjects in Group 1 became pregnant, resulting in uncomplicated live births and 12 subjects in Group 2 conceived, with nine successful live births and three first trimester, spontaneous abortion.Conclusions: Short –term rosiglitazone therapy enhances both spontaneous and clomiphene- induced ovulation in obese women with polycystic ovarian syndrome. Rosiglitazone therapy improves insulin sensitivity and decreases hyperandrogenaemia primarily through increases in Sex hormone binding globulin.Keyword: Roseglitazone, polycystic ovary syndrome, clomiphene citrate.