Objectives: In women with severe clomiphene-resistant PCOS, we proposed that
the insulin-lowering agent troglitazone (Rezulin®) could have a positive impact on the ovarian microenvironment by supporting normal follicular growth, ovulation, and successful pregnancy.
Design: Observational and prospective, in an academic-affiliated subspecialty private practice.
Methods: Clomiphene-resistant women (n=22) were referred by their gynecologists for subspecialty fertility care, with a desire to avoid gonadotropin therapy. All women were evaluated in detail for objective evidence of anovulation, polycystic ovaries, insulin resistance, androgen excess, and dyslipidemias, and written informed consent was obtained prior to prescribing troglitazone.
Results: Of 22 patients, 21 (95%) had documented ovulatory cycles, and 19 continued in active treatment beyond one cycle. Of 16/19 women continuing with troglitazone ± clomiphene, 13/16 (81%) achieved a pregnancy
Conclusions: A high percentage of women with clomiphene-resistant PCOS manifest treatable insulin resistance