Seyam E, et al. - In women with clomiphene citrate resistant polycystic ovarian disease (CCR-PCOD), researchers explored the role of the serum level of tumor necrosis factor alpha (TNF-&alphs;) and other polycystic ovarian disease (PCOD) relevant clinical and biochemical factors as a predictor of spontaneous ovulation after laparoscopic ovarian drilling (LOD). TNF-α, LH (lutienzing hormone), and Androstenedione could be considered as reliable predictors to recruit the ideal women candidates with CCR-PCOD; to have the maximum benefits after LOD treatment option.

Methods

• Researchers undertook a prospective research work, where they recruited 150 infertile women with CCR-PCOD.
• They investigated TNF-α serum level, which is an inflammatory biomarker, in addition to other PCOD relevant clinical and biochemical parameters as possible predictors of successful spontaneous ovulation and subsequent pregnancy after LOD.

Results

• Within the first 3 months follow up after LOD, recruited women with higher preoperative levels of TNF-α, LH, and androstenedione showed markedly higher rates of spontaneous ovulation, in contrast to obese women with BMI ≥25 kg/m², long duration of infertility ≥3 years, marked biochemical hyperandrogenism (testosterone levels ≥4.5 nmol/L, free androgen index ≥15), and high insulin resistance (IR).
• Spontaneous ovulation was observed in 95 (63.3%) women in between women regularly menstruated (105 = 70%); of these, 35(36.8%) women got pregnant spontaneously during the first 3 months follow up.
• Sixty-one women got pregnant during the extended follow up period of 12 months; cumulative pregnancy rate was 58%.
• In logistic regression, for spontaneous ovulation after LOD, the best cut-off values were 65.1 pg/ml, 11.5 IU/l, and 3.1 ng/ml and with a sensitivity of 91%, 88%, 55%, and with a specificity of 85%, 79%, 78%, for TNF-α, LH, androstenedione serum level respectively.