role of metformin in improving reproductive outcome in patients with polycystic ovary syndrome who are resistant to clomiphene citrate alone

ABSTRACT

To determine whether metformin treatment increases the ovulation and pregnancy rates in response to Clomiphene Citrate [CC] in women with polycystic ovary syndrome [PCOS] who are resistant to CC alone. Randomized, double- blind, placebo- controlled trial. Anovulatory women with PCOS who were resistant to CC were chosen. Participants received placebo or metformin, 500 mg three times daily, for 7 weeks. Information on reproductive steroids, gonadotropins, and oral glucose tolerance testing were obtained at baseline and after treatment. Metformin or placebo was continued and CC was begun at 50 mg daily for 5 days. Serum Progesterone [P] level >12 nanomol/L was considered to indicate ovulation. With ovulation, the daily CC dose was not changed, but with anovulation it was increased by 50 mg for the next cycles. Patients completed the study when they have six avulatory cycles, became pregnant, or experienced anovulation while receiving 200 mg of CC. In the metformin and placebo groups, 16 of 21 participants [76%] and 7 of 25 participants [28%] ovulated, and 11 of 20 participants [55%] and 2 of 24 participants [8.4%] conceived, respectively. Comparisons between the groups were statistically significant. In anovlatory women with PCOS who are resistant to CC, metformin use significantly increased ovulation and pregnancy rate when combined with CC