Background: Clomiphene responsiveness has been varied in WHO group II
anovulatory patients. Our study evaluates factors associated with clomiphene
citrate responsiveness in this population. Various parameters were studied,
including anthropometric, hormonal and transvaginal ultrasonographic
measurements. Methods: A retrospective case-control study was done over
a period of three years. A total of 260 women with WHO group II anovulatory
related infertility treated with clomiphene citrate 100 mg/d for five consecutive
days were enrolled. 173 women were categorized in clomiphene citrate resonsive
group (CCR), defined as patients with at least one dominant follicle 17
mm or at least 2 dominant follicles 15 mm. 87 women were categorized in
the non-ovulatory group (NCCR), defined as patients who not meet the responsive
group criteria. Various clinical, metabolic, hormonal and ultrasound features
were compared between two groups. Logistic regression analysis was used to
analyze the significant factors. Results: Among all participants, the
mean age was 32.6 4.0 years. The mean body mass index in CCR and NCCR
group was 23.9 10.7 kg/m and 24.0 4.0 kg/m,
respectively. The mean waist-hip ratio (WHR) of the NCCR group was higher than
that of the CCR group, i.e., 0.83 0.06 vs 0.81 0.05 (p =
0.004). The waist-hip ratio was the most sensitive anthropometric predictor of
non-responsiveness to clomiphene: cut-off value of 0.775 (90.8% sensitivity and
20.2% specificity) and cut-off value of 0.805 (73.6% sensitivity and 42.2%
specificity). Age, clinical hyperandrogenism, polycystic ovarian morphology, low
antral follicle count (5 follicles), baseline follicle-stimulating
hormones and estradiol levels were not significantly different.
Conclusions: The waist-hip ratio is a clinically useful parameter in
predicting clomiphene responsiveness in normogonadotropic anovulatory women (WHO
group II anovulation).