RCOG World Congress 2023

Ovulation Induction Response in Non-Obese Versus Obese Women with Polycystic Ovarian Syndrome
Authors; Shazia Syed, Unsa Malik, NighatNaheed, IsmatBatool, HinaGul

Background: More than 80% of premenopausal females presenting with Polycystic Ovarian Syndrome (PCOS) have above average BMI. 1 Obesity enhances the magnitude of hormonal and metabolic disturbances leading to anovulation.

Objective: To validate the influence of obesity on response of ovulation induction (OI) by Clomiphene citrate in PCOS related subfertility

Study Design & Setting: Comparative Analytical study (Dec 2020-Dec 2021) at Fertility Clinic of Benazir Bhutto Tertiary Care Hospital, Rawalpindi, Pakistan. Method: Rotterdam criteria used to diagnose PCOS. Women were recruited through non probability consecutive sampling. WHO criteria of BMI=23 kg/m² cutoffs for Asian population used to divide women in; non-obese (Group-A < 23 kg/m²) and obese/overweight (Group-B ≥ 23 kg/m²). OI done with Clomiphene Citrate 50mg/day for Day 2- 6 of the cycle. If failed response, dose was increased by 50mg/month up to 150mg/day maximum over 3 cycles. Response was assessed via ultrasound follicular tracking, Day 21 serum progesterone and B-HCG levels 02 weeks after HCG injection. Data analyzed on SPSS-version 23.0. Continuous variables calculated as Mean/Standard Deviation & categorical variables as Frequency/Percentage. P value < 0.05 considered significant.

Results:

•Total participants 200 (100 in each group).

• Mean age & mean BMI shown in Fig.01.

•Comparison of Rotterdam criteria shows (Table.01) that difference in symptoms of Oligomenorrhoea and amenorrhoea in two groups was significant, P-value (0.009).

•Difference in LH:FSH ratio and Ultrasound features of PCOS were insignificant.

•The difference in majority of OI parameters between two groups was statistically significant. (Table.02)

Discussion;

PCOS is the leading cause of anovulatory subfertility. Almost 80% of the women with PCOS have ovulatory dysfunction manifested as oligomenorrhea/amenorrhea.2 In our study 97% obese women had oligomenorrhea and 3% had amenorrhea comparable with a past study 3 where amenorrhea was 5.6% but oligomenorrhoea was in 27.10% cases. LH:FSH ratio was much less and insignificant in index study compared with 94% in another study.4 The highest prevalence of polycystic ovarian morphology (PCOM) in a past study was 53% 5 compared to 100% in index study. This difference can probably be attributable to ethnic variation. The difference in majority of Ovulation Induction parameters between two groups was statistically significant compared to multiple other studies.6-10

Conclusion: Obesity control and lifestyle modification are imperative for significant improvement in fertility outcomes for PCOS related subfertility.

References;

1.Silvestris E, de Pergola G, Rosania R, Loverro G. Obesity as disruptor of the female fertility. Reproductive Biology and Endocrinology. 2018;16(1):1-3.

2.Dokras A, Stener-Victorin E, Yildiz BO, Li R, Ottey S, Shah D, et al. Androgen Excess- PCOS Society: position statement on depression, anxiety, quality of life, and eating disorders in PCOS. Fertility and sterility. 2018;109(5):888-99.

3.Cheema HK, Arora R. Prevalence and Clinical Profile of Patients with PCOS-A Hospital Based Study. J. Evolution Med. Dent. Sci .2019;8(32):2573-76.

4.Esmaeilzadeh S, Andarieh MG, Ghadimi R, Delavar MA. Body mass index and gonadotropin hormones (LH & FSH) associate with clinical symptoms among women with PCOS. Global journal of health science. 2015;7(2):101.

5.Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, et al. The prevalence of PCOS in a normal population according to the Rotterdam criteria versus revised criteria including anti-Müllerian hormone. Human reproduction. 2014;29(4):791-801.

6.Zegers-Hochschild F, Adamson GD, De Mouzon J, Ishihara O, Mansour R, Nygren K, et al. The ICMART and WHO revised glossary on ART terminology. Human reproduction. 2009;24(11):2683-7.

7.Ellakwa HE, Sanad ZF, Hamza HA, Emara MA, Elsayed MA. Predictors of patient responses to ovulation induction with clomiphene citrate in patients with PCOS experiencing infertility. Int J Gynaecol Obstet. 2016; 133 (1): 59-63

8.Khakwani M, Parveen R, Yousaf S, Tareen AU. Efficacy of letrozole versus clomiphene citrate on ovulation induction in patients with PCOS. Pak J Med Sci. 2022;38(5):1155-58.

9.Kar S. Clomiphene citrate or letrozole as first-line ovulation induction drug in infertile PCOS women: A prospective randomized trial. JHum Reprod Sci. 2012;5(3):262-65.

10.Agrawal K, Gainder S, Dhaliwal LK, Suri V. Ovulation induction using Clomiphene Citrate using stair - step regimen versus traditional regimen in PCOS - A Randomized Control Trial. J Hum Reprod Sci. 2017;10(4):261-64.

RCOG World Congress 2023

Ovulation Induction Response in Non-Obese Versus Obese Women with Polycystic Ovarian Syndrome

Poster Presenter

Authors

Affiliations

Part of Topic