[Treatment of polycystic ovary syndrome and related infertility with clomiphene resistance by compound cyproterone acetate]

Abstract

Objective: To assess the efficacy and safety of compound cyproterone acetate (CPA Co, or Diane-35) in the treatment of polycystic ovary syndrome (PCOS) and to explore its potential role in improving the outcome of ovulation induction in clomiphene (CC) resistant cases.

Methods: Twenty-nine proven PCOS patients were enrolled. Seventeen out of them, including 16 who were resistant to CC, had anovulatory infertility. CPA Co was given for 4-6 cycles. Serum luteinizing hormone(LH), follicle stimulating hormone(FSH), estradiol(E2), testosterone(T), androstenedione(A), dehydroepiandrosterone (Ds), sex hormone binding globvlin (SHBG), insulin concentrations, total cholesterol, triglycerides(TG), high density lipoprotein-cholesterol(HDL-C), low density lipoprotein-cholesterol (LDL-C), apolipoprotein A, apolipoprotein B and transvaginal pelvic ultrasonography were determined before, 2-3 cycles and 4-6 cycles after treatment. After stopping the drug, CC or human menopausal gonadotropin were re-administered in 12 patients (22 cycles) and 5 cases (6 cycles) respectively for induction of ovulation.

Results: All patients had regular uterine bleeding during CPA Co therapy. Acne improved in 8 cases. Hirsute score didn't decrease significantly. Serum LH, FSH, E2, A, T, Ds concentrations decreased significantly (P < 0.05-0.01), while SHBG levels increased by 5.1 times after treatment. Meanwhile, bilateral ovarian volumes shrunk and follicle numbers decreased significantly (P < 0.05-0.01). Serum insulin levels did not change significantly. As to the lipid profile, the most striking change was 55.1% increase of HDL-C and 23.0% decrease of LDL-C, although TG also increased by 36.2%. 58.6% of patients had mild and transient adverse effects. Serum alanine transaminase increased in 3 cases. After stopping treatment, CC induced 5.3% (by cases) or 45.4% (by cycles) ovulation rate and 2 pregnancies achieved in 12 CC resistant patients.

Conclusion: CPA Co has antiandrogenic effects on PCOS patients clinically, biochemically and in ovarian morphology. Pretreatment of CPA Co may play a role in improving the outcome of ovulation induction in CC resistant cases.