SERUM-INSULIN IN CLOMIPHENE RESPONDERS AND NONRESPONDERS WITH POLYCYSTIC OVARIAN DISEASE

Objective. To investigate insulin levels in women with polycystic ovar ian disease (PCOD) who are responders or nonresponders to clomiphene c itrate (CC). Design. Open and prospective study. Setting. Outpatient i nfertility clinic of a third level medical institution. Patients. Ten healthy women (group 1) and 35 PCOD women classified as responders (gr oup 2 n = 10) or nonresponders (group 3 n = 25) on the basis of serum progesterone greater than or equal to 19 nmol/L in response to CC repe atedly 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 i n a 100-g, 2-hours oral glucose tolerance test (OGTT). Main outcome me asures. Serum glucose, insulin, free testosterone (free-T), dehydroepi androsterone sulphate (DHEA-S), and androstenedione (A) were determine d in the samples OGTT and the areas under the curve (AUG) were calcula ted. Results. Group 3 had higher BMI, basal LH, and insulin and AUC in sulin than groups 1 and 2; free-T was higher in groups 2 and 3 than in group;, and basal PRL was higher in group 2 compared to groups 1 and 3. When BMI less than or equal to 25.4 kg/m(2) (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 conce ntration 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.