Can sex-hormone binding globulin considered as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome?

ABSTRACT

This study aims to evaluate the sex hormone binding globulin [SHBG] level as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome [PCOS]. This study was conducted in 2009-2012 in Isfahan, Iran. Anovulatory women with a diagnosis of PCOS were studied. Metformin was started at 500 mg three times a day. If no ovulation occurred, Clomiphene citrate was added. The study comprised 273 infertile women with PCOS completed the study, 75 [28%] of them became pregnant 6 months after treatment [7.36% with metformin and 20.14% with metformin and clomiphene citrate]. Patients who responded to metformin treatment had significantly lower mean SHBG levels compared to those who did not [0.88+0.32vs. 0.2642+0.44 nmol/L, respectively, P<0.0001]. The area under the ROC curve [AUC] for prediction the response to treatment was 0.85. The baseline level of 27 was the most appropriate cut of point HSBG for the prediction of conception. HSBG had a sensitivity of 88%, and specificity of 73.6%. It had a false positive level of 26.4% and false negative level of 12%. Its positive predictive value was 56.4% and its negative predictive value was 94%. The chance of conception increased for reducing a unit of fpg [OR = 0.69; 95% CI = 0.54-0.86; P = .002], as well as reducing of every unit of HSBG [OR = 0.47; 95% CI = 0.39-0.56; P <0.001], and for reducing each unit of insulin in [OR = 0.082; 95% CI = 1.021-0.33; P <0.001]. HSBG test is suggested as an appropriate test for predicting pregnancy achievement of PCOs women after pharmacological treatment