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

Wajdi, Wasan

	Predictors of Rosiglitazone Success in Ovulation Induction among Women with Polycystic Ovary Syndrome Resistant to Clomiphene Citrate
IRAQI JOURNALOF COMMUNITY MEDICINE
Article 1, Volume 26, Issue 2, 2013, Pages 158-161
Author
Wasan Wajdi
Abstract
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.
Keywords
Roseglitazone; polycystic ovary syndrome; clomiphene citrate

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