OBJECTIVE:To study the serum levels of insulin, insulin-like growth factor I (IGF-I), and insulin-like growth factor binding protein-1 (IGFBP-1) in relation to clomiphene citrate (CC) responsiveness in women with polycystic ovarian disease (PCOD).DESIGN:Prospective. PATIENTS, SETTING: Twenty-three women with PCOD admitted consecutively to the University Infertility Clinic, a tertiary referral center.INTERVENTIONS:Blood samples were taken at fasting state and during oral glucose tolerance test (OGTT) for the determination of insulin, IGF-I, and IGFBP-1. A dose of 50 to 200 mg/d CC was given for ovulation induction.RESULTS:With CC treatment, ovulation was achieved in 13 of 23 PCOD patients. The IGFBP-1 concentration was lower in CC nonresponders than in CC responders (20.5 +/- 4.0 ng/mL versus 41.0 +/- 8.5 ng/mL) (P < 0.05). This difference was accentuated in 13 lean PCOD patients. Lean CC nonresponders (n = 7) had almost threefold lower serum IGFBP-1 levels than lean CC responders (n = 6) (24.0 +/- 3.1 ng/mL versus 61.8 +/- 8.6 ng/mL) (P < 0.01). By contrast, among 10 obese PCOD patients, the IGFBP-1 levels were low irrespective of CC responsiveness (14.8 +/- 8.0 ng/mL versus 16.7 +/- 7.2 ng/mL). The differences remained during OGTT. The concentrations of IGF-I, insulin, sex hormone-binding globulin, LH, FSH, and androgens showed no significant differences between CC responders and nonresponders. There was an inverse correlation between serum insulin and IGFBP-1 levels in obese PCOD patients, whereas this was not seen in lean patients.CONCLUSION:In lean PCOD patients, low serum IGFBP-1 concentration is related to CC unresponsiveness by a mechanism unrelated to insulin.

Increased responses of plasma insulin and endorphins to the oral glucose tolerance test (oGTT) have earlier been found in obese women. We studied responses of immunoreactive beta-endorphin (ir beta-E) and insulin in plasma to the oGTT in 8 non-obese women with polycystic ovaries (PCO) and in 10 healthy women. An additional control group consisted of 5 healthy women who were fasting during the study period. In the PCO group the insulin and glucose responses to the oGTT were increased, and an increase of ir beta-E from 5.9 +/- 1.5 to 8.6 +/- 2.8 pmol/l was found during the 1st half-hour period of the oGTT. In contrast, no significant change was found during the oGTT in healthy women (3.2 +/- 0.5 and 2.7 +/- 0.65 pmol/l, respectively), and in the fasting control women the mean ir beta-E level (+/- SE) decreased, from 4.5 +/- 1.2 to 3.6 +/- 1.1 pmol/l. These findings revealed increased responses of both plasma ir beta-E and insulin to the oGTT in non-obese women with PCO but their possible causal relationship remained unsolved.