"Evaluation of the Clinical Outcome of Vitamin E as Adjuvant Therapy in Patients with Clomiphene Citrate Resistant Polycystic Ovary Syndrome"

Abstract

Infertility is a complex disorder with significant medical, psychological and economic aspects which affects up to 53 million people worldwide. Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder affecting fertility with prevalence in populations ranged from six percent to 13 percent. It is traditionally thought of as a triad of oligomenorrhea, hirsutism, and obesity. Morover, it is recognized as endocrine disorder that results in overproduction of androgens, primarily from the ovary, and is associated with insulin resistance (IR). Because many women who have PCOS have the onset of symptoms during adolescence, it is important to be able to recognize and understand this disorder so as to facilitate treatment and prevention of long-term sequelae.

Currently, clomiphene citrate (CC) is considered first-line therapy for ovulation induction for women with PCOS and infertility. It has variable efficacy with approximately 20–25 percent of women are CC resistant.

It is important to notice that oxidative stress (OS) is one of the important factors in pathogenesis of PCOS subjects. Some data indicate that the oxidants to antioxidants ratio is higher in PCOS women, regardless of any metabolic abnormalities. It reported that antioxidant administration can be associated with improved endocrine and metabolic characteristics in women with PCOS. Besides, it has been shown that vitamin E administration have the potential to increase implantation and ongoing pregnancy rate in infertile women possibly via endometrial environment improvement due to its antioxidant effects. Therefore, the aim of this study was to evaluate the efficacy and safety of adding vitamin E to CC and metformin for ovulation induction in CC resistance PCOS women.

A prospective, randomized, controlled, open label study was conducted on 60 PCOS women recruited from the Teaching University Hospital of Fayoum University and a licensed medical Center of Infertility in Banī Suef, Egypt between July, 2018 and March, 2019. Women with PCOS, diagnosed according to the revised 2003 Rotterdam consensus criteria, were included if they were < 40 years with infertelity period more than one year and CC resistance. Exclusion criteria included, DM, hypertension, liver or kidney malfunction, heart disease, persistent hyperprolactinemia, thyroid dysfunction, gonadotropin induction.