Predictors of Chances to Conceive in Ovulatory Patients during Clomiphene Citrate Induction of Ovulation in Normogonadotropic Oligoamenorrheic Infertility

Abstract

The present prospective follow-up study was designed to identify whether clinical, endocrine, or ultrasound characteristics assessed by standardized initial screening of normogonadotropic oligo/amenorrheic infertile patients could predict conception in 160 women who reached ovulation after clomiphene citrate (CC) medication. Additional inclusion criteria were total motile sperm count of the partner above 1 million and a negative history for any tubal disease. Daily CC doses of 50 mg (increasing up to 150 mg in case of absent ovarian response) from cycle days 3-7 were used. First conception (defined as a positive urinary pregnancy test) was the end point for this study. A cumulative conception rate of 73% was reached within 9 CC-induced ovulatory cycles. Patients who did conceive presented more frequently with lower age (P < 0.0001) and amenorrhea (P < 0.05) upon initial screening. In a univariate analysis, patients with elevated initial serum LH concentrations (>7.0 IU/L) had a higher probability of conceiving (P < 0.01). In a multivariate analysis, age and cycle history (oligomenorrhea vs. amenorrhea) were identified as the only significant parameters for prediction of conception. These observations suggest that there is more to be gained from CC ovulation induction in younger women presenting with profound oligomenorrhea or amenorrhea. Screening characteristics involved in the prediction of ovulation after CC medication in normogonadotropic oligo/amenorrheic patients (body weight and hyperandrogenemia, as shown previously) are distinctly different from predictors of conception in ovulatory CC patients (age and the severity of cycle abnormality). This disparity suggests that the FSH threshold (magnitude of FSH required for stimulation of ongoing follicle growth and ovulation) and oocyte quality (chances for conception in ovulatory cycles) may be differentially regulated.

Parameters for calcium metabolism in women with polycystic ovary syndrome who undergo clomiphene citrate stimulation: a prospective cohort study

“…This is in accordance with previous observations (13,26). It has been suggested that the association of hypovitaminosis D with features of PCOS may be associated with obesity but not with the presence of PCOS (27).…”

Comparison of embryological and clinical outcome in GnRH antagonist vs. GnRH agonist protocols for in vitro fertilization in PCOS non-obese patients. A prospective randomized study

“…Since LH determines the final stage of the oocyte nucleus maturation and the degeneration of gap junctions, the elevated levels of LH may also activate premature meiotic cleavage, damage the oocyte nucleus and lead to apoptosis [21]. High LH concentrations in patients with PCOS have been associated with an increased rate of miscarriage [22], although it has been questioned recently [23,24]. Increased androgen concentration in follicular fluid induced by elevated LH may block the dominant follicle selection and cause the follicle degeneration.…”

FSH response-dose can be predicted in ovulation induction for normogonadotropic anovulatory infertility

“…Sonographic monitoring was performed by a single observer (E v S), using an ultrasound machine (model EUB-415; Hitachi Medical Corp., Tokyo, Japan) with a 6.5 MHz transvaginal transducer. Endocrine screening included serum assays for FSH, luteinizing hormone, estradiol (E2), androstenedione, testosterone, sex-hormone binding globulin and insulin-like growth factor-I (IGF-I), as described previously (16). Hormone assays used and the intra-and inter-assay coefficients of variation for these assays have all been described previously (11,16).…”