Follicle stimulating hormone receptor polymorphism affects the outcome of ovulation induction in normogonadotropic World Health Organization class 2 anovulatory subfertility

Capsule:
An FSH receptor polymorphism (rs6166) affects the outcome of ovulation induction in normogonadotropic anovulatory subfertility. The minor allele (680Ser) is associated with Clomiphene-resistant anovulation during treatment with clomiphene citrate.

Authors:
Olivier Valkenburg, M.D., Evert J.P. van Santbrink, Ph.D., Tamar E. König, M.D., Axel P.N. Themmen, Ph.D., André G. Uitterlinden, Ph.D., Bart C.J.M. Fauser, Ph.D., Cornelis B. Lambalk, Ph.D., Joop S.E. Laven, Ph.D.

Volume 103, Issue 4, Pages 1081-1088

Abstract:

Objective:
To assess whether an FSH receptor polymorphism (Asn680Ser, rs6166) can affect the outcome of ovulation induction in normogonadotropic (World Health Organization class 2 [WHO2]) anovulatory subfertile women.

Design:
Prospective, longitudinal, cohort study.

Setting:
University-based fertility unit.

Patient(s):
A total of 240 consecutive women diagnosed with WHO2 anovulatory subfertility who underwent ovulation induction therapy. Results were replicated in a retrospective cohort of 185 patients with polycystic ovary syndrome (PCOS) (Rotterdam criteria).

Intervention(s):
Ovulation induction using clomiphene citrate (CC) as first-line and exogenous gonadotropins (exFSH) as second-line therapy.

Main Outcome Measure(s):
Clomiphene-resistant anovulation (CRA), clomiphene failure (CCF), and ongoing pregnancy rate.

Result(s):
Genotyped patients (n = 159) were similar to nongenotyped women (n = 81) regarding clinical characteristics and outcomes of ovulation induction. The 680Ser allele was associated with CRA. A pooled analysis of both cohorts showed an 89% higher chance of CRA after CC treatment (odds ratio 1.9 [95% confidence interval 1.1–3.3]) in homozygous carriers of the FSH receptor variant (680Ser/Ser). A lower chance of ongoing pregnancy (hazard ratio 0.51 [95% confidence interval 0.27–0.98]) was observed among these patients during CC treatment in the prospective cohort.

Conclusion(s):
An FSH receptor polymorphism is associated with CRA during treatment with clomiphene citrate. These data ma

  • Shvetha Zarek

    Kudos to the authors for providing bench to bedside research on the use of FSHR genotyping and evaluating clomiphene resistance and failure. Given that the objective is to evaluate CRA, CCF and OPR by different genotypes, what was the rationale for providing baseline characteristics and outcomes based on genotyping and not being genotyped in Table 1? The cohort that was not genotyped is not an ideal control since there may be patients with the genotypes of interest (exposure) in the control group. Was there selection criteria for conducting patient genotyping that could bias the results? It would be helpful in Table 2 to provide the number of patients who had each genotype in order for the reader to assess if the study is adequately powered. Overall, this is an incredibly interesting study that could prove to be useful in clinical practice in diagnosing the etiology of clomiphene resistance and failure. Thank you.

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