BACKGROUND: Endogenous opiates may affect various aspects of reproductive and metabolic function in patients
with polycystic ovary syndrome (PCOS). This study evaluated long-term inhibition of the opioid system using
naltrexone in clomiphene citrate (CC)-resistant women with PCOS. METHODS: A group of 30 infertile females
with PCOS were evaluated; all subjects were obese, hyperandrogenic and hyperinsulinemic; 16 patients were
amenorrhic and 14 were oligomenorrhic. All subjects received natrexone (50 mg p.o. daily) for 6 months. Patients
who did not ovulate after 12 weeks of naltrexone monotherapy, also received CC (starting at 50 mg/day for 5 days
and, for non-responders, increasing it up to 150 mg/day). RESULTS: Of the 30 women, 3 ovulated during naltrexone
monotherapy and 19 of the remaining 27 ovulated during naltrexone 1 CC therapy. There were no conceptions during
naltrexone monotherapy, but 9 of 27 women (33.3%) conceived during naltrexone 1 CC; there was one missed abortion
at 9 weeks, one preterm delivery at 34 weeks and seven term live births. Naltrexone therapy was also followed by
significant reductions in BMI, fasting serum insulin, luteinizing hormone (LH), LH/follicle-stimulating hormone ratio
and testosterone. CONCLUSIONS: In this preliminary trial, naltrexone improved endocrine and metabolic function in
women with CC-resistant PCOS. Furthermore, naltrexone restored CC sensitivity in the majority of subjects, resulting
in a significant number of pregnancies.