Kahyaoglu Serkan, Yumuşak Omer Hamid, Ozyer Sebnem, Pekcan Meryem Kuru, Erel Merve, Cicek Mahmut Nedim, Erkaya Salim, Tasci Yasemin
Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
Int J Fertil Steril. 2017 Jan-Mar;10(4):320-326. doi: 10.22074/ijfs.2016.4849. Epub 2016 Nov 1.
Polycystic ovary syndrome (PCOS) is highly associated with an ovulatory infertility, features of the metabolic syndrome, including obesity, insulin resistance and dyslipidemia. Serum concentrations of high sensitive C-reactive protein (hs-CRP) were significantly higher in obese than in non-obese PCOS patients at baseline, suggesting a relationship between elevated hs-CRP levels and obesity. The aim of this study was to evaluate whether cycle day 3 hs-CRP levels before clomiphene citrate (CC) treatment would predict cycle outcomes in women with PCOS.
This cross-sectional study was conducted among 84 infertile women with PCOS who were treated with CC at Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey, between January 2014 and January 2015. Based on the exclusion criteria, cycle outcomes of remaining 66 infertile women with PCOS treated with CC were analyzed. The hs-CRP levels and insulin resistance indexes were evaluated on day 3 of the CC treatment cycle. The primary outcome measures were number of preovulatory follicles measuring≥17 mm and pregnancy rates.
The mean ± SD age of the patients was 24.0 ± 3.8 years (range 18-36). The mean ± SD body mass index (BMI) of the patients was 25.7 ± 4.9 (range 17-43). Fifty patients developed dominant follicle (75%) and 5 patients established clinical pregnancy during the study (clinical pregnancy rate: 7%). The mean ± SD baseline hs-CRP, fasting insulin and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) values of the patients with and without dominant follicle generation during treatment cycle were 6.42 ± 7.05 and 4.41 ± 2.95 (P=0.27), 11.61 ± 6.94 and 10.95 ± 5.65 (P=0.73), 2.68 ± 1.79 and 2.41 ± 1.30 (P=0.58), respectively. The mean ± SD baseline hs-CRP, fasting insulin and HOMA-IR values of the patients with and without clinical pregnancy establishment following treatment cycle were 6.30 ± 2.56 and 5.90 ± 6.57 (P=0.89), 11.60 ± 7.54 and 11.44 ± 6.61 (P=0.95), 2.42 ± 1.51 and 2.63 ± 1.70 (P=0.79), respectively.
In this study, we did not observe a predictive value of cycle day 3 hs-CRP levels on preovulatory follicle development and pregnancy rates among infertile PCOS patients treated with CC. Also, no relationship between HOMA-IR values and dominant follicle generation or clinical pregnancy establishment was demonstrated in our study, confirming the previous studies emphasizing the neutral effect of metformin utilization before and/or during ovulation induction to pregnancy rates.
多囊卵巢综合征（PCOS）与排卵性不孕症以及代谢综合征的特征密切相关，包括肥胖、胰岛素抵抗和血脂异常。在基线时，肥胖的PCOS患者血清高敏C反应蛋白（hs-CRP）浓度显著高于非肥胖的PCOS患者，提示hs-CRP水平升高与肥胖之间存在关联。本研究的目的是评估枸橼酸氯米芬（CC）治疗前月经周期第3天的hs-CRP水平是否能预测PCOS女性的周期结局。
本横断面研究于2014年1月至2015年1月在土耳其安卡拉的泽凯·塔希尔·布拉克妇女健康教育与研究医院对84例接受CC治疗的PCOS不孕女性进行。根据排除标准，分析了其余66例接受CC治疗的PCOS不孕女性的周期结局。在CC治疗周期的第3天评估hs-CRP水平和胰岛素抵抗指数。主要结局指标为直径≥17 mm的排卵前卵泡数量和妊娠率。
患者的平均年龄±标准差为24.0±3.8岁（范围18 - 36岁）。患者的平均体重指数（BMI）±标准差为25.7±4.9（范围17 - 43）。在研究期间，50例患者出现优势卵泡（75%），5例患者临床妊娠（临床妊娠率：7%）。治疗周期中出现和未出现优势卵泡的患者，其平均±标准差的基线hs-CRP、空腹胰岛素和稳态模型评估胰岛素抵抗（HOMA-IR）值分别为6.42±7.05和4.41±2.95（P = 0.27）、11.61±6.94和10.95±5.65（P = 0.73）、2.68±1.79和2.41±1.30（P = 0.58）。治疗周期后有和无临床妊娠的患者，其平均±标准差的基线hs-CRP、空腹胰岛素和HOMA-IR值分别为6.30±2.56和5.90±6.57（P = 0.89）、11.60±7.54和11.44±6.61（P = 0.95）、2.42±1.51和2.63±1.70（P = 0.79）。
在本研究中，我们未观察到月经周期第3天的hs-CRP水平对接受CC治疗的PCOS不孕患者的排卵前卵泡发育和妊娠率有预测价值。此外，在我们的研究中未证明HOMA-IR值与优势卵泡生成或临床妊娠之间存在关联，这证实了先前强调在排卵诱导前和/或期间使用二甲双胍对妊娠率无影响的研究。
