Haifa Al-Shaheen
CABOG, Consultant Obstetrician & Gynecologist, Basrah Maternity & Childhood Hospital
This prospected follow–up study was carried out over 12 months period (from 1st
September 2008 till 30th August 2009) in infertility clinic in Basrah maternity and child
hospital to evaluate whether certain criteria assessed during initial screening (number of
follicles and ovarian volume) could predict the response to ovulation induction with
clomiphene citrate (CC) medication.
Clinical, ultrasonographic and endocrine data were collected and analyzed on 58 women
with oligomenorrhoea or secondary amenorrhoea with PCOS and infertility before
initiation of CC medication. The ovarian morphology were determined by transvaginal
U/S which showed all women had altered ovarian morphology ( both ovaries had >10
multiple small cyst of 2-9 mm, mean total follicular number (11.0±2.5) and enlarged
ovaries, mean ovarian volume (13.2±4.01). Thirty eight patients (65%) ovulate, the
remaining 20 (35%) did not. Age, body mass index (BMI), ovarian volume, number of
small follicles, serum LH, testosterone and LH/FSH ratio in CC non responders were all
significantly higher than in CC responders (P< 0.05).
Data suggest that patients whose ovarian are less likely to respond to stimulation by CC
treatment, can be predicted on the basis of initial screening characteristics, such as:
BMI, history (oligomenorrhoea, or secondary amenorrhoea) and number of follicles and
mean ovarian volume.
These ultrasonographic features & laboratory assays could be clinically useful for
distinguishing better the CC no responders from responders.
These observations may add to ongoing discussion regarding etiological factors
involved in ovarian dysfunction in these patients and classification of anovulatory
infertile women.