Predicting factors of clomiphene citrate responsiveness in infertile women with normogonadotropic anovulation (WHO group II anovulation)

Abstract

Predicting factors of clomiphene citrate responsiveness in infertile women with normogonadotropic anovulation (WHO group II anovulation) Theeraporn Areetheerapas1 , Artitaya Singwongsa2,*, Komsun Suwannarurk1 , Junya Pattaraarchachai3 1Department of obstetrics and gynecology, Thammasat University Hospital, 12120 Pathum Thani, Thailand 2Department of obstetrics and gynecology, Ramathibodi Hospital, Mahidol University, 10400 Bangkok, Thailand 3Chulabhorn International College of Medicine, Thammasat University, 12120 Pathum Thani, Thailand *Correspondence: artitaya.sin@mahidol.ac.th (Artitaya Singwongsa) Academic Editor: Michael H. Dahan Submitted: 27 August 2021 Revised: 26 October 2021 Accepted: 4 November 2021 Published: 9 February 2022 Abstract Background: Clomiphene responsiveness has been varied in WHO group II anovulatory patients. Our study evaluates factors associated with clomiphene citrate responsiveness in this population. Various parameters were studied, including anthropometric, hormonal and transvaginal ultrasonographic measurements. Methods: A retrospective case-control study was done over a period of three years. A total of 260 women with WHO group II anovulatory related infertility treated with clomiphene citrate 100 mg/d for five consecutive days were enrolled. 173 women were categorized in clomiphene citrate resonsive group (CCR), defined as patients with at least one dominant follicle ≥17 mm or at least 2 dominant follicles ≥15 mm. 87 women were categorized in the non-ovulatory group (NCCR), defined as patients who not meet the responsive group criteria. Various clinical, metabolic, hormonal and ultrasound features were compared between two groups. Logistic regression analysis was used to analyze the significant factors. Results: Among all participants, the mean age was 32.6 ± 4.0 years. The mean body mass index in CCR and NCCR group was 23.9 ± 10.7 kg/m2 and 24.0 ± 4.0 kg/m2 , respectively. The mean waist-hip ratio (WHR) of the NCCR group was higher than that of the CCR group, i.e., 0.83 ± 0.06 vs 0.81 ± 0.05 (p = 0.004). The waist-hip ratio was the most sensitive anthropometric predictor of non-responsiveness to clomiphene: cut-off value of 0.775 (90.8% sensitivity and 20.2% specificity) and cut-off value of 0.805 (73.6% sensitivity and 42.2% specificity). Age, clinical hyperandrogenism, polycystic ovarian morphology, low antral follicle count (≤5 follicles), baseline follicle-stimulating hormones and estradiol levels were not significantly different. Conclusions: The waist-hip ratio is a clinically useful parameter in predicting clomiphene responsiveness in normogonadotropic anovulatory women (WHO group II anovulation). Keywords: Clomiphene response; Anovulatory infertility; Ovulation induction