Background and Objectives: Clomiphene citrate is the first line drug for ovulation induction in WHO Group II subfertile women (normoestrogenic, normogonadotropic).

Objectives: To compare the physical and hormonal profile of responders and non-responders. To formulate and assess a predictive score for clomiphene citrate (CC) response.

Materials and Methods: This comparative analytical study was done in the Gynecology Department, Benazir Bhutto Hospital, Rawalpindi. WHO Group II subfertile women who underwent CC therapy, from January 2016 to January 2017, were selected into two groups; Responders; 30 patients who ovulated and Non-responders; 30 patients who remained anovulatory. Patients with tubal and uterine subfertility were excluded. Menstrual history, BMI, hirsutism and Thyroid Stimulating Hormone (TSH) levels of the patients were studied. Descriptive statistics were calculated using SPSS version 21. Mann Whitney U Test, Independent Sample t Test and Chi Square Test were applied to assess the significance of variables.

Results: Among Responders, mean BMI was low (23.27­± 2.46) with 80% patients having normal BMI (≤ 24.9). All responders had TSH levels within the normal range. 93.3% of the responders had regular and 6.7% had irregular menstrual cycles. Hirsutism was present in 16.7% patients.

Among Non-Responders, mean BMI was high (27.57± 3.39), where only 10 % had normal BMI (≤ 24.9) while; 63.3% were overweight (BMI 25-29.9) and 26.7% obese (BMI ≥ 30). In this group 43.3% patients had abnormal TSH levels. Similarly 70% patients had regular and 30% had irregular menstrual cycles. All studied variables were statistically significant between the two groups (p<0.05). A predictive score for CC response was formulated considering these variables. Score 0 was given for all normal variables that is BMI≤24.9, TSH = 0.4-4.2 µU/ml, absence of hirsutism and regular menstrual cycle each. As these parameters became abnormal score 1 or 2 (only for overweight women) was given. Scoring ranged from 0-5. According to the predictive score, all responders had a score from 0 to 2 while 70% of non-responders had a score of 2 and above (p<0.05).

Conclusion: According to the predictive score, greater the score, lesser the chances to ovulate on CC therapy. Response prior to therapy can be predicted, enabling the doctors to intervene in patient’s physical and hormonal factors responsible for decreased response, hence modifying the treatment modalities for ovulation induction.

Keywords: Clomiphene, Ovulation, Hirsutism, Scoring