Clomiphene citrate changes metabolite content of follicular fluid of PCOS women.

OBJECTIVE: To determine whether clomiphene citrate (CC) treatment affects the metabolite contents of a dominant follicle in polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: Twenty non-obese primary infertile anovulatory PCOS women undergoing CC treatment and ten fertile women were enrolled. 6 out of 20 patients had impaired glucose tolerance test (IGT). CC was given at a dose of 150 mg on days 3-7 of cycles in the first group. 10 fertile women with a regular menstrual cycle and normal ovaries during ultrasound examination were accepted as control group. They were not given any drug for ovarian stimulation. Transvaginal sonography and follicular tracking were done to each group of participant. Both groups of subjects underwent magnetic resonance spectroscopy when the dominant follicle with a mean diameter of at least 16-18 mm was detected. Lactate (Lac), N-acetylaspartate (NAA), creatine 1 (Cr1), creatine 2 (Cr2) and choline (Cho) signal of dominant follicles were measured. Peak of each metabolite was measured in units. Voxels were placed in the center of dominant follicle. RESULTS: Compared to control group significantly decreased Cho signal was found in follicular fluid of PCOS subjects taking clomiphene. Almost three-fold decline in Cho signal was detected in PCOS group compared to Cho signal of control group (0.64±1.01 vs. 2.01 ±1.13). On the other hand, significantly increased Lac signal was detected in the dominant follicle of PCOS subjects taking clomiphene compared to control group. Almost 2 fold increase in Lac signal was noted after clomiphene treatment (1.90±0.32 vs. 0.93±2.21). The results of spectroscopy signals obtained from PCOS subjects without IGT and PCOS subjects with IGT were similar. CONCLUSIONS: Unbalanced production of Cho signal in the follicular fluid may have occurred secondary to membrane damage of cumulus-oocyte-complexes due to CC therapy.

AFC vs. AMH: prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation.

OBJECTIVE: To assess the clinical value of antral follicle count (AFC) and anti-Mullerian hormone (AMH) for the prediction of ovarian response in women with endometrioma undergoing controlled ovarian stimulation for IVF using GnRH antagonist treatment. PATIENTS AND METHODS: Fifty patients with endometrioma who underwent their first IVF/ICSI cycle with GnRH antagonist treatment were included in the study. The average AMH values were recorded as 1.5-2 ng/mL. Fifty infertile women are not suffering from endometrioma were selected from those with male factor infertility as control. They were matched according to both serum AMH levels and age. Serum samples have been collected before the IVF treatment for determining AMH levels in both groups of subjects. Likewise, each group of subject underwent ultrasound scan for AFC on day 3. Total number of oocytes retrieved during OPU, the number of transferred embryo, implantation and clinical pregnancy rates, live birth and abortion rates, total dose of rhFSH were noted in both groups of subjects. RESULTS: Day 3 AFC was significantly higher in the control group compared to women with endometrioma. Both the number of retrieved oocytes during oocyte pick-up, MII oocytes and 2 PN embryo were significantly lower in the endometrioma. Likewise, the fertilization, implantation, clinical pregnancy and live birth rates of endometrioma group were significantly lower than those in the control group. The total rFSH dose was higher in the endometrioma group than those in control. The percentage of abortion in the endometrioma group was found to higher compared to those with controls. CONCLUSIONS: AFC is more sensitive than the AMH in detecting ovarian response in women with ovarian endometrioma. The individualization of GnRH antagonist protocols in subjects having endometrioma might be improved by using an AFC-tailored approach instead of AMH.