Predictors of Patients Remaining Anovulatory during Clomiphene Citrate Induction of Ovulation in Normogonadotropic Oligoamenorrheic Infertility

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Abstract
The diagnostic criteria used to identify patients suffering fromud polycystic ovary syndrome remain controversial. The present prospectiveud longitudinal follow-up study was designed to identify whether certainud criteria assessed during standardized initial screening could predict theud response to ovulation induction with clomiphene citrate (CC) in 201ud patients presenting with oligomenorrhea or amenorrhea and infertility.ud Serum FSH levels were within the normal range (1-10 IU/L), and allud patients underwent spontaneous or progestin-induced withdrawal bleeding.ud Initial CC doses were 50 mg daily for 5 days starting on cycle day 3. Inud the case of an absent response, doses were increased to 100 and 150 mgud daily in subsequent cycles. First ovulation with CC was used as the endud point. After a complete follow-up (in the case of a nonresponse, at leastud 3 treatment cycles with daily CC doses up to 150 mg), 156 patients (78%)ud ovulated. The free androgen index (FAI = testosterone/sex hormone-bindingud globulin ratio), body mass index (BMI), cycle history (oligomenorrhea vs.ud amenorrhea), serum androgen (testosterone and/or androstenedione) levels,ud and mean ovarian volume assessed by transvaginal sonography were allud significantly different (P < 0.01) in responders from those inud nonresponders. FAI was chosen to be the best predictor in univariateud analysis. The area under the receiver operating characteristics curve in aud multivariate prediction model including FAI, BMI, cycle history, and meanud ovarian volume was 0.82. Patients whose ovaries are less likely to respondud to stimulation by FSH due to CC treatment can be predicted on the basis ofud initial screening characteristics, such as FAI, BMI, cycle historyud (oligomenorrhea or amenorrhea), and mean ovarian volume. Theseud observations may add to ongoing discussion regarding etiological factorsud involved in ovarian dysfunction in these patients and classification ofud normogonadotropic anovulatory infertile women

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