New therapeutic strategy for increasing pregnancy rate in clomiphene citrate-resistant PCOS patients

Objective: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive-aged women, with infertility due to anovulation affecting approximately ۷۵% of patients. This study evaluates a novel therapeutic strategy for clomiphene citrate (CC)-resistant PCOS patients unresponsive to conventional treatment. Materials & Methods: A total of ۳۸۰ PCOS patients with ultra-high anti-Müllerian hormone (AMH >۱۰ ng/mL) and antral follicle count (AFC >۱۲) were enrolled based on inclusion and exclusion criteria. The control group received ۵۰ mg/day CC from days ۳ to ۹ of the menstrual cycle for up to three cycles if ovulation did not occur. The intervention group (OCP-CC) received oral contraceptive pills (OCPs) for three months starting on day ۲ of the menstrual cycle, followed by ۱۵۰ mg/day CC from days ۳ to ۹. In both groups, follicular growth was monitored from day ۱۰, and purified urinary human chorionic gonadotropin (hCG) was administered when at least three follicles reached ۱۸–۲۰ mm in diameter. Pregnancy rates and predictive factors, including age, weight, height, body mass index (BMI), education level, infertility duration, insulin resistance, and AMH and follicle-stimulating hormone (FSH) levels, were analyzed in CC-resistant PCOS patients. Results: The OCP-CC group exhibited a significantly higher pregnancy rate compared to the CC-alone group (۵۰.۸% vs. ۴۹.۲%, P=۰.۰۳). No significant differences were observed in age, weight, height, BMI, infertility duration, or education level between CC-resistant and CC-sensitive PCOS patients (P>۰.۰۵). However, insulin resistance was significantly higher in CC-resistant patients who responded to OCP-CC therapy compared to those without CC resistance (P=۰.۰۳). Conclusions: The OCP-CC strategy significantly improves pregnancy rates in CC-resistant PCOS patients with anovulatory infertility. Insulin resistance serves as a valuable predictor of treatment response to CC in infertile PCOS patients.

کلیدواژه ها:

Polycystic ovary syndrome ، clomiphene citrate ، oral contraceptive pills ، insulin resistance ، pregnancy rate ، anovulatory infertility