Table 1.
Baseline mean distribution in the clomiphene sensitive and clomiphene resistant groups and respective p-values
| Parameters | Overall (MEAN±SD) (N=164) | Clomiphene resistant (MEAN±SD) (N=88) | Clomiphene sensitive (MEAN±SD) (N=76) | p-value |
|---|---|---|---|---|
| Age in years | 27.98±3.739 | 27.99±3.97 | 27.97±3.48 | 0.980 |
| BMI1 in kg/m2 | 26.077±4.306 | 27.12±4.16 | 24.88±4.19 | 0.001 |
| Waist circumference in inches | 33.63±3.72 | 34.28±3.37 | 32.89±3.98 | 0.017 |
| Waist-hip ratio | 0.88±0.044 | 0.89±0.04 | 0.87±0.05 | 0.008 |
| Ferriman Gallwey score | 13.98±3.75 | 16.11±2.87 | 11.20±3.30 | 0.0001 |
| Testosterone (nmol/l) | 2.74±1.28 | 3.30±1.39 | 2.08±0.735 | 0.0001 |
| Androstenedione (ng/ml) | 2.97±1.36 | 3.54±1.53 | 2.31±0.723 | 0.0001 |
| OGTT2- FASTING (mg/dl) | 90.14±13.07 | 92.65±14.79 | 87.24±10.08 | 0.008 |
| OGTT2- 1 HOUR (mg/dl) | 148.02±35.22 | 158.33±36.05 | 136.08±30.325 | 0.0001 |
| OGTT2- 2 HOUR (mg/dl) | 130.73±29.37 | 137.57±29.94 | 122.82±26.67 | 0.001 |
| Fastingi (mIU/L) | 11.89±6.83 | 14.68±6.62 | 8.65±5.55 | 0.0001 |
| HOMA-IR3 | 2.73±1.81 | 3.43±1.85 | 1.92±1.39 | 0.0001 |
| Serum triglycerides (mg/dl) | 133.11±50.91 | 146.35±60.93 | 117.19±29.71 | 0.0001 |
| Serum cholesterol (mg/dl) | 171.12±43.01 | 190.66±37.00 | 148.48±38.28 | 0.0001 |
| LDL4 (mg/dl) | 110.55±0.06 | 118.82±25.26 | 100.97±18.31 | 0.0001 |
| HDL5 (mg/dl) | 47.98±9.67 | 44.41±8.08 | 52.12±9.76 | 0.0001 |
| AMH6 (ng/ml) | 10.58±5.00 | 12.22±5.62 | 8.69±3.30 | 0.0001 |
| Mean ovarian volume in cm3 | 12.52±3.07 | 13.65±3.26 | 11.21±2.23 | 0.001 |
| Mean AFC7 | 11.81±3.17 | 13.19±3.07 | 10.21±2.47 | 0.000 |
| Baseline LH8 (IU/l) | 13.53±7.42 | 14.81±8.05 | 12.04±6.34 | 0.007 |
| Baseline FSH9 (IU/l) | 5.84±2.50 | 6.02±2.72 | 5.64±2.22 | 0.241 |
| LH8-FSH9 ratio | 2.48±1.18 | 2.66±1.22 | 2.27±1.11 | 0.035 |
| 17 OHP10 (ng/dl) | 1.38±0.77 | 1.49±0.8 | 1.26±0.7 | 0.062 |
1-BMI- Body Mass Index, 2- OGTT- Oral Glucose Tolerance Test, 3- HOMAIR-Homeostatic Model Assessment Insulin Resistance, 4-LDL- Low Density Glycoprotein, 5-HDL- High Density Glycoprotein, 6- AMH- Anti Mullerian Hormone, 7-AFC- Antral Follicle Count, 8-LH- Luteinizing Hormone, 9-FSH- Follicle Stimulating Hormone, 10-17OHP- 17-Hydroxyprogesterone
To establish predictors of non-responsiveness to clomiphene citrate, logistic regression analysis was done.
In univariate regression analysis (Table 2) between CC-resistant and CC-sensitive PCOS women, BMI, waist circumference, Ferriman-Gallwey score, oral glucose tolerance test (OGTT)- fasting/1 hr/2 hr values, HOMA-IR, LDL, HDL, triglyceride, cholesterol, androstenedione, AMH, LH- FSH ratio, ovarian volume, and antral follicle count were found to be statistically significant. However, in multivariate logistic regression (Table 3), only Ferriman-Gallwey score, androstenedione levels, HDL and cholesterol were found to be the independent predictor of non-responsiveness to clomiphene citrate.