The More You Go East? Clinical And Ethnic Considerations Regarding The Prevalence Of Clomiphene Citrate Resistant Polycystic Ovarian Syndrome Infertility.
Abstract
Objective: Although statistical reports and registries are available on one side only, namely Western studies, we support the view that the prevalence of Clomiphene Citrate resistant polycystic ovarian syndrome (PCOS) should be higher among Middle and Far Eastern communities. We try to propose clinical and ethnic based explanations for these differences.
Participants and Methods: Electronic literature search was conducted using the following web based search engines: www.pubmed.com, www.sciencedirect.com, www.springer.de. The keywords used were the single and combinations of the following: clomiphene, resistance, polycystic ovary, PCOS, resistant, clomiphene citrate resistant. All relevant studies reporting treatment, prevalence and/or outcomes of clomiphene citrate resistant PCOS infertility were included.
Results: No studies reporting prevalence of this condition were found. We found 21 relevant studies which reported the treatment and/or outcomes of the condition. Seven studies, mostly abstracts at international conferences, were excluded because they reported a limited number of patients (less than 15 patients each). While Studies coming from Western countries had limited numbers of patients (3 studies reporting 40, 80 and 83 patients), recruited over long periods (36-45 months). On the other hand, studies from Egypt, Iran and India showed larger numbers (range from 100 to 1387 patients) recruited over strikingly shorter periods (24-35 months).
Conclusions: Despite no accurate statistical records exist, there seems to be a high prevalence of CC resistant PCOS in Middle and Far East countries, particularly Egypt, India and Iran. This trend could be secondary to, or associated with high prevalence of hepatitis C infection, chronic liver disease, insulin resistance and obesity.
Participants and Methods: Electronic literature search was conducted using the following web based search engines: www.pubmed.com, www.sciencedirect.com, www.springer.de. The keywords used were the single and combinations of the following: clomiphene, resistance, polycystic ovary, PCOS, resistant, clomiphene citrate resistant. All relevant studies reporting treatment, prevalence and/or outcomes of clomiphene citrate resistant PCOS infertility were included.
Results: No studies reporting prevalence of this condition were found. We found 21 relevant studies which reported the treatment and/or outcomes of the condition. Seven studies, mostly abstracts at international conferences, were excluded because they reported a limited number of patients (less than 15 patients each). While Studies coming from Western countries had limited numbers of patients (3 studies reporting 40, 80 and 83 patients), recruited over long periods (36-45 months). On the other hand, studies from Egypt, Iran and India showed larger numbers (range from 100 to 1387 patients) recruited over strikingly shorter periods (24-35 months).
Conclusions: Despite no accurate statistical records exist, there seems to be a high prevalence of CC resistant PCOS in Middle and Far East countries, particularly Egypt, India and Iran. This trend could be secondary to, or associated with high prevalence of hepatitis C infection, chronic liver disease, insulin resistance and obesity.