Serum insulin in clomiphene responders and nonresponders with polycystic ovarian disease.

OBJECTIVE

To investigate insulin levels in women with polycystic ovarian disease (PCOD) who are responders or nonresponders to clomiphene citrate (CC).

DESIGN

Open and prospective study.

SETTING

Outpatient infertility clinic of a third level medical institution.

PATIENTS

Ten healthy women (group 1) and 35 PCOD women classified as responders (group 2 n = 10) or nonresponders (group 3 n = 25) on the basis of serum progesterone > or = 19 nmol/L in response to CC repeatedly administered in doses up to 250 mg/day for five days; they were further subdivided if body mass index (BMI) was below (N) or above (H) mean + 3 SD of group 1.

INTERVENTIONS

Blood samples were obtained in a 100-g, 2-hours oral glucose tolerance test (OGTT).

MAIN OUTCOME MEASURES

Serum glucose, insulin, free testosterone (free-T), dehydroepiandrosterone sulphate (DHEA-S), and androstenedione (A) were determined in the samples OGTT and the areas under the curve (AUC) were calculated.

RESULTS

Group 3 had higher BMI, basal LH, and insulin and AUC insulin than groups 1 and 2; free-T was higher in groups 2 and 3 than in group 1, and basal PRL was higher in group 2 compared to groups 1 and 3. When BMI < or = 25.4 kg/m2 (mean + 1 SD of group 1) 77% of the PCOD cases responded (10 out of 13) whereas none with BMI > 25.4 responded to CC (n = 22) irrespectively of basal insulin concentration or AUC insulin.

CONCLUSION

Moderate to excessive overweight seems more frequently and closely associated to a negative CC response in women with PCOD than hyperinsulinemia.