What factors predict the outcome of clomiphene citrate ovarian stimulation in women with polycystic ovarian syndrome?

This study investigated factors affecting controlled ovarian stimulation (COS) with clomiphene citrate (CC) in women with polycystic ovary syndrome (PCOS). 

They found that low anti-mullerian hormone (AMH) and high endometrial thickness (EMT) are associated with higher clinical pregnancy rate (CPR) in these women.

Polycystic ovarian syndrome (PCOS) is a very common condition. Women with PCOS have disordered hormone levels. This means that they may not ovulate normally. This can cause fertility problems. Controlled ovarian stimulation (COS) is used in these women. COS involves using a drug or hormone to stimulate the release of an egg from the ovary. Clomiphene citrate (CC) is one drug commonly used. 

CC has been used for many years in COS. Some newer drugs have shown better fertility outcomes. However other factors can affect fertility outcomes. Endometrial thickness (EMT) is important to determine if a pregnancy will occur. PCOS patients also have high levels of anti-Mullerian hormone (AMH). High AMH may be associated with poor development of the endometrium (the lining of the uterus). It is unclear if EMT or AMH affect fertility outcomes in PCOS after COS with CC. 

This study included 89 women with PCOS. Women were selected based on their treatment with CC for COS.  All women underwent the same COS procedure. The main fertility outcomes evaluated were follicle maturation (FM) and clinical pregnancy rate (CPR). FM is the process where an egg is released from a follicle into the uterus. EMT was measured using ultrasound at midcycle. AMH levels were also measured.  

Higher EMT was associated with higher CPR. The optimal level of EMT for pregnancy was more than or equal to 8 mm. Low AMH was associated with higher EMT levels. Higher AML levels (above 7 ng/ml) were associated with lower CPR. High levels of other hormones including luteinizing hormone (LH) and testosterone were associated with lower CPR. 

The authors concluded that low AMH and high EMT are associated with higher CPR in women with PCOS undergoing CC ovarian stimulation.

The number of patients in this study was low. The average body mass index (BMI) was 25kg/m². This could be considered low for PCOS women. Studies show that a high BMI also affects COS outcomes. More studies are needed in larger populations. 

If you have any concerns regarding infertility please consult with your physician.