Association of increased total antioxidant capacity and anovulation in nonobese infertile patients with clomiphene citrate-resistant polycystic ovary syndrome

Objective: To investigate whether total antioxidant capacity (TAC) could predict the response to ovulation induction to clomiphene citrate (CC) in nonobese women with polycystic ovary syndrome. Design: Prospective longitudinal follow-up study. Setting: Academic hospital. Patient(s): Fifty-five nonobese, oligomenorrheic women with polycystic ovary syndrome and normal indices of insulin sensitivity. Intervention(S): None. Main Outcome Measure(s): Standard clinical examinations and ultrasonographic and endocrine screening, including FSH, LH, E-2, F, total T, sex hormone-binding globulin, DHEAS, and TAC were performed before initiation of CC medication. Result(s): Within the total group, 27 (49%) of the patients did not ovulate at the end of follow-up. TAC, free androgen index, and ovarian volume were all significantly different in CC nonresponders from those in responders. Total antioxidant capacity was found to be the best predictor in univariate analysis (odds ratio, 171.55; 95% confidence interval, 10.61-2,772.93), and it had the highest area in the receiver operating characteristics analysis (0.91). In a multivariate prediction model, TAC, free androgen index, and ovarian volume showed good predictive power, with Hosmer-Lemeshow goodness of fit test of 0.80. Conclusion(s): Total antioxidant capacity was the strongest predictor of ovarian response during CC induction of ovulation in these patients. It can be concluded that TAC can be used as a routine screening test.