Insulin resistance in clomiphene responders and non-responders with polycystic ovarian disease and therapeutic effects of metformin

• Published in: International journal of gynecology and obstetrics Vol. 75; no. 1; pp. 43 - 50
• Main Authors: Parsanezhad, M.E, Alborzi, S, Zarei, A, Dehbashi, S, Omrani, Gh
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-10-2001; Elsevier Science
• Subjects: Adult; Analysis of Variance; Biological and medical sciences; Blood Glucose - drug effects; Body Mass Index; Clomiphene; Clomiphene - metabolism; Clomiphene - therapeutic use; Female; Female genital diseases; Fertility Agents, Female - metabolism; Fertility Agents, Female - therapeutic use; Gonadal Steroid Hormones - blood; Gynecology. Andrology. Obstetrics; Humans; Infertility, Female - drug therapy; Infertility, Female - metabolism; Insulin; Insulin - blood; Insulin Resistance - physiology; Medical sciences; Metformin; Metformin - metabolism; Metformin - therapeutic use; Non tumoral diseases; Obesity - metabolism; Polycystic ovarian disease; Polycystic Ovary Syndrome - drug therapy; Polycystic Ovary Syndrome - metabolism; Prospective Studies; Regression Analysis; Tropical medicine; Iran; Asia; Polycystic ovarian disease; Clomiphene; Metformin; Insulin; Human; Treatment efficiency; Female sterility; Review; Clomifene; Polycystic ovary; Female genital diseases; Resistance; Ovarian diseases; Chemotherapy; Treatment; Biguanides; Clinical biology; Cyst; Adult; Female; Benign neoplasm; Hormonal investigation; Comparative study; Responder
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/S0020-7292(01)00470-2

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.