Enhanced ovarian folliclular development by metformin does not correlate with pregnancy rate: a randomized trial

Polycystic ovary syndrome [PCOS] is a common, complex endocrine disorder for women of productive age. A high incidence of ovulation failure in women with PCOS is related to insulin resistance. Some studies have assessed the effects of hyperinsulinemia and insulin resistance in relationship with insulin sensitizing agents such as Metformin [Met]. These medicines have been suggested new scope for ovulation stimulation enhancement with Clomiphene Citrate [CC] in PCOs women. The aim of this study is to compare the effectiveness of adding Met to CC in women with PCOS. This multicenter, single-blind, randomized controlled trial study was performed on 334 PCOS patients from 2007 to 2009. Patients were randomly divided into two groups and ovulation induction was performed with either CC alone or CC + Met. The treatment was continued for three cycles, then the mature follicle and pregnancy rates were evaluated. In the CC + Met group, 68% had at least one dominant follicle in the first cycle that was significant [p<0.001], and 31.7% had one in the second cycle. In the CC group 54.5% in the first cycle, 31.7% second cycle, and 6.9% ovulated in the third cycle. The pregnancy rate was 28.7% in CC + Met group and 24.6% in the CC group, with no significant differences between the two groups. Adding Met to CC is significant for ovulation, but it does not enhance the pregnancy rate

Does adding dexamethasone to clomiphene citrate improve ovulation in PCOS patients? a triple - blind randomized clinical trial study

A common cause of anovulation is polycystic ovarian syndrome [PCOS]. Clomiphene citrate [CC] is the first line of treatment in PCOS patients however approximately 25% of patients may be CC-resistant. This study aimed to evaluate the efficacy of adding dexamethasone [dex] to CC in CC-resistant PCOS patients with the intent to improve ovulation. This randomized controlled trial study was performed on 60 infertile PCOS patients referred to our infertility research center from 2007 to 2009. Patients were randomly divided in two groups and stimulation performed with dex+CC or CC+placebo. Rates of ovulation, pregnancy and number of mature follicles were evaluated. Ovulation rate in the dex+CC group was 21 out of 30 [70%] and in the CC+placebo group it was 17 out of 30 [56.7%]. The pregnancy rate was 5 [16.7%] in the dex+CC group and 3 [10%] in the CC+placebo group. There was no significant difference between rates of ovulation and pregnancy in both groups, but the number of follicles >/= 18 mm were significant in the dex+CC group [p<0.05]. Our results showed that addition of dex to CC significantly increased the number of matured follicles, however the ovulation and pregnancy rates were comparable between the two groups