Ovulation Induction Response in Non-Obese Versus Obese Women with Polycystic Ovarian Syndrome at Fertility Clinic of a Tertiary Care Hospital, Rawalpindi

Unsa Malik; Shazia Syed; Sobia Nawaz; Sumaira Mubasher; Aisha Ishtiaq; Humaira Bilqis

doi:10.35787/jimdc.v13i3.1043

Unsa Malik
Shazia Syed Professor& Head of department, OBGYN, Rawalpindi Medical University
Sobia Nawaz Assistant Prof. OBGYN, Rawalpindi Medical University, Rawalpindi
Sumaira Mubasher Benazir Bhutto Hospital, Rawalpindi.
Aisha Ishtiaq Benazir Bhutto Hospital, Rawalpindi
Humaira Bilqis Rawalpindi Medical University

DOI: https://doi.org/10.35787/jimdc.v13i3.1043

Keywords: Polycystic ovarian syndrome, Subfertility, Ovulation induction, Clomiphene citrate

Abstract

Background: More than 80% of premenopausal females presenting with Polycystic Ovarian Syndrome (PCOS) have above average BMI. Obesity enhances the magnitude of hormonal and metabolic disturbances leading to anovulation.
Objective: To validate the influence of obesity on response of ovulation induction by Clomiphene citrate in PCOS related subfertility.
Methodology; Study Design & Setting: Comparative Analytical study at Fertility Clinic of Department of Obstet & Gynae, Benazir Bhutto Hospital, Rawalpindi.
Study Duration: Twelve months (Dec 2020-Dec 2021)
Method: Rotterdam criteria was used to diagnose PCOS. WHO criteria of BMI=23 kg/m² cutoffs for Asian population was used to divide women in two groups; non-obese (Group-A < 23 kg/m²) and obese/overweight (Group-B ≥ 23 kg/m²). In both groups ovulation was induced with Clomiphene Citrate and response was assessed via ultrasound follicular tracking, Day 21 serum progesterone and serum B-HCG levels two weeks after the HCG injection.
Results: Total participants were 200 (100 in each group). Mean age (years) in Group-A vs Group-B was 25.38 vs, 27.62 and mean BMI (kg/m²) was 20.82 vs 28.34 respectively. The frequent symptoms in Group-A Vs Group-B were Oligomenorrhoea (87% vs 97%) and amenorrhoea (13% vs 03%). P-value (0.009) was significant. Difference in Ultrasound features of PCOS and LH:FSH ratio in both groups were insignificant (P-value=0.214 and 0.316 respectively). The difference in almost all parameters of OI between the two groups was statistically significant. In Group-A vs Group-B; the presence of dominant follicle after Clomiphene citrate was 52% vs 34% (p value=0.01); Day 21 serum progesterone >30ng/ml was 21% vs 09% (p value=0.01); a positive serum β-HCG level >50 mIU/L 02 weeks after HCG administration was 12% vs 04% (p value=0.09).
Conclusion: Obesity control and lifestyle modification are imperative for significant improvement in fertility outcomes for PCOS related subfertility.