Clomiphene citrate response in PCOS patients with abnormal lipid profile and impaired glucose tolerance test

Objective: To assess the clomiphene citrate(CC) response to 200mg in women not responding to 150mg for ovulation induction in PCOS women with abnormal lipid profile and impaired glucose tolerance test, and to assess the postprandial triglyceride response to high fat meal in PCOS women
Design: controlled clinical study.
Setting: infertile PCOS women attending infertility centre in Al-Batool maternity Teaching Hospital.
Materials and methods: 50 infertile women with PCOS, who failed to respond to 150 mg clomiphene citrate (CC) fore 4cycles (25 non-obese and 25 over weight) were given 200mg of CC, and 25 healthy women as controls, were selected. Assessment for; Clinical, anthropometric measurement, fasting serum glucose, fasting lipid profile, oral glucose tolerance test, postprandial triglyceride, cholesterol, high and low density lipoprotein, hormonal assay, and ovarian ultrasound.
Results: Both obese and non-obese PCOS women with CC resistant (CCr) to 150mg when 200mg is used had a significant higher waist-to-hip ratio than controls at P≤0.05. PCOS women had higher levels of fasting, and 2-hour postprandial blood sugar (2h PPBS) and high-density lipoproteins (HDL) levels in a significant difference at P≤0.05. High-density lipoprotein was significantly lower in PCOS women than controls at P≤0.05. Clomiphene citrate response (CCR) was significantly less in PCOS groups with impaired glucose tolerance (IGT) 33.4% than those with normal blood sugar (BS) (81.8%), and higher in women with type 2 diabetes mellitus (DM) as (100%) were (CCr). CCr was more in PCOS women with abnormal lipid profile compared to normal (71.4% in abnormal triglyceride (Tg), 78.2% in abnormal cholesterol (Ch) and 67.7% with abnormal HDL.
Conclusion: PCOS women with IGT test; non-insulin dependent DM and abnormal lipid profile had more CCr in ovulation induction, than those with normal blood sugar and lipid profile. PCOS women had postprandial hypertriglyceridemia that is related to high waist-to-hip ratio, and insulin resistance regardless of obesity.

Keywords
PCOS, clomiphene citrate, abnormal lipid profile, impaired glucose tolerance.