Role of androgenic hyperactivity in anovulation

Area of Science:

• Endocrinology
• Reproductive Medicine
• Clinical Chemistry

Background:

• Clomiphene-resistant anovulation affects numerous patients.
• Androgenic hyperactivity is a common comorbidity in these cases.
• Accurate diagnosis of androgenic disorders is crucial for effective treatment.

Purpose of the Study:

• To evaluate the utility of urinary 17-ketosteroid (17-KS) fractionation for diagnosing androgenic disorders in clomiphene-resistant anovulation.
• To differentiate between adrenal, ovarian, and mixed origins of androgen excess.
• To assess the response to dexamethasone suppression and human chorionic gonadotropin (HCG) stimulation tests.

Main Methods:

• Investigated 60 patients with clomiphene-resistant anovulation.
• Utilized rapid chromatography for fractionation of urinary 17-KS.
• Administered dexamethasone suppression and HCG stimulation tests.
• Analyzed treatment outcomes including conception and ovulation.

Main Results:

• 35 patients (58.3%) exhibited androgenic hyperactivity.
• Fractionated 17-KS levels were elevated in most cases, unlike total 17-KS.
• Dexamethasone suppressed 17-KS in adrenal and mixed cases, but not ovarian.
• HCG stimulation increased 17-KS in ovarian and mixed cases, but not adrenal.
• 22 of 34 treated patients conceived, with 21 successful deliveries.

Conclusions:

• Urinary 17-KS fractionation is a practical and reliable method for diagnosing androgenic disorders in anovulation.
• Hormonal testing (dexamethasone and HCG) aids in classifying the origin of androgen excess.
• Treatment strategies incorporating dexamethasone and clomiphene are effective in achieving ovulation and pregnancy.