Clinical, ultrasonographic and endocrine predictors of ovarian response to clomiphene citrate in normogonadotropic anovulatory infertility

Objective: To identify screening characteristics involved in the prediction of anovulation after clomiphene citrate (CC) medication. Design: Prospective follow-up study Setting: Infertility Clinic, University Department of Obstetrics and Gynecology and Department of Medical Biochemistry, Faculty of Medicine, Alexandria. Materials and Methods: 60 patients presenting with oligomenorrhea or amenorrhea and infertility. Clinical, ultrasonographic and endocrine screening took place before initiation of CC medication. Endocrine screening included serum assays for LH, FSH, fasting insulin, glucose, leptin, inhibin B, testosterone and androstenedione. Results: 22 patients (36.6% of the total group) did not ovulate. Age, body mass index (BMI), ovarian volume, Doppler indices of ovarian stromal blood vessels, the LH/FSH ratio serum insulin, leptin, inhibin-B, testosterone and androstenedione differed significantly between CC responders and non-responders. However, forward stepwise multivariate analyses revealed a final prediction model for CC resistant anovulation including BMI, serum insulin and androstenedione. Conclusions: Data suggest that obesity, hyperinsulinaemia and hyper- androgenaemia are crucial factors involved in ovarian dysfunction that prevent response to CC

Detection of endometrial pinopodes by scanning electron microscopy in hormone-controlled and stimulated cycles

Objective: To assess the effects of clomiphene citrate (CC) and combined oral contraceptive pills (COP) on endometrial pinopode expression. Design: Prospective study. Setting: Department of Obstetrics and Gynecology and Department of Histology, Faculty of Medicine, Alexandria university. Patients: Thirty volunteers with regular menstrual cycles were divided randomly into: group I (n=10) received COP, group II (n=10) received CC and group III (n=10) served as controls. Interventions: Sequential endometrial biopsies obtained by a pipelle during the luteal phase. Main outcome measures: Assessment of endometrial pinopodes by scanning electron microscopy (SEM). Results: Ninety endometrial samples were evaluated under SEM. Fully developed pinopodes appeared in only one sample per cycle indicating their short life span and there were individual variations in the timing of pinopode expression in the same group. COP retarded the appearance of fully developed pinopodes (mean day = 22.4±0.7) whereas CC accelerated their appearance (mean day = 17.9±0.9) compared to controls (mean day = 20.4±0.5). Conclusions: Advanced endometrial maturation and early pinopode expression in stimulated cycles may reflect shifts in the window of receptivity, resulting in ovo-endometrial asynchrony and limiting implantation success