Effect of Rosiglitazone on Clomiphene Citrate-Induced Ovulation in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive age women. A novel therapeutic approach has emerged from the observation that most women with PCOS suffer from insulin resistance and compensatory hyperinsulinemia. The chronic hyperinsulinemia leads to overproduction of ovarian androgens. The high levels of androgen lead to chronic anovulation, menstrual disturbances and hirsutism. We evaluated the use of rosiglitazone in cases of PCOS. to determine whether rosiglitazone therapy would improve the ovulation rate when given with clomiphene to cases of PCOS. The study included 52 females with PCOS. The primary outcome was ovulation as determined by folliculometry. Subjects were randomized into either group (I) or group (II). Group (I) subjects started clomiphene lOOmg daily on day 5 for 5 days. Group (II) subjects started rosiglitazone maleate 4mg daily on the first day of the cycle for 14 days together with clomiphene lOOmg daily started on day 5 for 5 days. Subjects of group (I) (clomiphene alone) who failed to ovulate after 3 months treatment were given the same treatment as group (II), they were designated as group (III), in group (I), fourteen cases out of 26 showed ovulation (53.8%), pregnancy occurred in 6/26 cases (23%). In group (II), twenty two cases out of 26 showed ovulation (84.6%). Pregnancy occurred in 9/26 cases (34.6%). In group (III) eight cases out of 12 showed ovulation (66.67%) while pregnancy occurred in 3/12 cases (25%). In group (II), we obtained a pregnancy rate of 34.62% within 3 treatment cycles compared to a pregnancy rate of 23.08% using clomiphene alone within the same treatment duration. Our results are comparable to those of previous workers who have used rosiglitazone in addition to clomiphene in PCOS patients. Also, our results concerning the effect of rosiglitazone and clomiphene on ovulation are comparable to results obtained by the use of a combination of metformin and clomiphene. in conclusion, short-term rosiglitazone therapy significantly enhances clomiphene- induced ovulation especially in overweight and obese women with PCOS.