Role of rosiglitazone in induction of ovulation in obese women with polycystic ovary syndrome and insulin resistance

ABSTRACT

To evaluate the role of rosiglitazone in treatment of obese polycystic ovarian women with insulin resistance and its effect on ovulation induction and pregnancy outcome together with looking for any synergistic effect of metformin when combined with rosiglitazone. Double blind, randomized, prospective, placebo-controlled trial. Kasr El-Aini Teaching Hospital Cairo University, Egypt. 75 obese women with PCOS and insulin resistance. Patients were divided into three groups with 25 women each. During the first month, the first group received rosiglitazone alone, the second group received a combination of resiglitazone-metformin and the third group received placebo. All participants had a base-line measurement of total testosterone level together with and oral glucose tolerance test for determination of insulin resistance in terms of fasting glucose and insulin and peak insulin levels. Ovulation was then induced for all patients using CC and HMG for one month while continuing the original medication. Re-assessment of total testosterone level and fasting glucose and insulin was then done at the end of the two months study period. Primary outcome measures are changes in serum total testosterone level and in measures of insulin resistance. The secondary outcome measures are the occurrence of ovulation and pregnancy rates. The two groups receiving insulin sensitizers showed marked improvement in insulin resistance. However, no improvement in hyperandrogenemia was elicited which may be due short duration of exposure. They also demonstrated high ovulation and pregnancy rates with a significant difference compared to the placebo group. These findings suggest that short-term rosiglitazone therapy is effective in improving insulin sensitivity and patient's response to induction of ovulation in obese PCOS cases with insulin resistance. Furthermore, combination of metformin-rosiglitazone did not prove superiority over the use of rosiglitazone alone