Clomiphene citrate treatment cycle outcomes of PCOS patients based on basal HS-CRP levels: a cross-sectional study

Objective Polycystic ovary syndrome (PCOS) is highly associated with anovulatory infertility, features of the metabolic syndrome, including obesity, insulin resistance and dyslipidemia. Serum concentrations of high sensitive C- reactive protein (hs-CRP) were significantly higher in obese than in non-obese PCOS patients at baseline suggesting that the relationship between elevated hs-CRP levels and obesity. The aim of this study was to evaluate whether cycle day 3 hs-CRP levels before clomiphene citrate (CC) treatment would predict cycle outcomes in women with PCOS. MaterialsAndMethods This cross-sectional study was conducted among 84 infertile women with PCOS who were treated with CC. Based on the exclusion criteriae, cycle outcomes of remaining 66 infertile women with PCOS who were treated with CC were analysed. The hs-CRP levels and insulin resistance indexes were evaluated on cycle day 3 of the CC treatment cycle. The primary outcome measures were number of preovulatory follicles measuring ≥ 17 mm and pregnancy rates. Results The mean±SD age of the patients was 24.0±3.8 years (range 18–36). The mean±SD body mass index (BMI) of the patients was 25.7±4.9 (range 17-43). Fifty patients have developed dominant follicle (75%) and 5 patients have established clinical pregnancy during the study (Clinical pregnancy rate: 7%). The mean±SD baseline hs-CRP, fasting insulin and HOMA-IR values of the patients with and without dominant follicle generation during treatment cycle were 6.42±7.05 and 4.41±2.95, 11.61±6.94 and 10.95±5.65, 2.68±1.79 and 2.41±1.30 respectively (p=0.27, p=0.73, p=0.58). The mean±SD baseline hs-CRP, fasting insulin and HOMA-IR values of the patients with and without clinical pregnancy establishment following treatment cycle were 6.30±2.56 and 5.90±6.57, 11.60±7.54 and 11.44±6.61, 2.42±1.51 and 2.63±1.70 respectively (p=0.89, p=0.95, p=0.79). Conclusion In this study, we did not observe a predictive value of cyle day 3 hs-CRP levels on preovulatory follicle development and pregnancy rates among infertile PCOS patients treated with CC. Also, no relationship between HOMA-IR values and dominant follicle generation or clinical pregnancy establishment has been demonstrated in our study confirming the previous studies emphasizing the neutral effect of metformin utilization before and/or during ovulation induction to pregnancy rates.