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. 2001 Nov;18(11):608–611. doi: 10.1023/A:1013165006406

Improved Responsiveness of PCOS Patients to Clomiphene After CYP17a Inhibitor

Hassan Ali Hassan 1,2, Dalal El-Gezeiry 1,3, Tamer M Nafaa 1, Iman Baghdady 2
PMCID: PMC3455693  PMID: 11804430

Abstract

Purpose: To study the effect of CYP17a inhibitor, “ketoconazole,” on clomiphene responsiveness in PCOS patients.

Methods: Prospective analysis was employed with the setup at Alexandria IVF/ICSI center. Ninety-seven insulin-resistant PCOS patients undergoing ovulation induction using clomiphene citrate were randomly divided, by random number table, into two groups. The first group (n = 49) received ketoconazole (400 mg daily) till correction of metabolic syndrome followed by clomiphene (100 mg/day); the second group (n = 48) receiving clomiphene without ketoconazole pretreatment. Main outcome measures were incidence of clomiphene resistance, monofollicular response, fasting insulin/glucose ratio, serum testosterone, and pregnancy rates.

Results: The ketoconazole group showed significantly (p < 0.05) higher incidence of monofollicular response (38%), higher pregnancy rates, and significantly less marked antiestrogenic manifestations than did the control group. They also had significantly lower incidence of clomiphene resistance (11.6%), lower serum testosterone levels, less hyperinsulinaemia, than did the control group.

Conclusion: Ketoconazole improved clomiphene responsivenss in PCOS patients and attenuated its untoward biological effects.

Keywords: clomiphene resistance, CYP17a inhibitor, hyperandrogenism, insulin resistance, ketoconazole, PCOS

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