title: Sequential treatment of metformin and clomiphene citrate in clomiphene-resistant women with polycystic ovary syndrome: a randomized, controlled trial.
abstract: BACKGROUND
  Recognition of the importance of insulin resistance in clomiphene-resistant women with polycystic ovary syndrome (PCOS) has led to the use of insulin sensitizers.
  
  
  METHODS
  A randomized, controlled trial was conducted to compare efficacy of sequential treatment with metformin and clomiphene citrate with conventional gonadotrophins. Sixty clomiphene-resistant women with PCOS were randomized to two groups (n = 30 each), using computer-generated tables. Group I received metformin for 6 months, followed by ovulation induction with clomiphene citrate; group II received hMG for ovulation induction. Hormonal profiles were evaluated at the onset and after completion of treatment.
  
  
  RESULTS
  There was no significant difference in pregnancy rates between the two groups (16.7 versus 23.3%). In group I, there was a significant improvement in menstrual function and ovulation after treatment (40%, P < 0.001; and 46.7%, P < 0.001), with a significant decrease in fasting insulin levels (P < 0.05). There were no changes in other biochemical parameters. The ovulation rate in group II was 43.3%, with a high drop-out rate. The cost-effective analysis for medications per pregnancy in group I was US$ 71 +/- 3 versus US$ 277 +/- 171 in group II.
  
  
  CONCLUSIONS
  Sequential treatment with metformin and clomiphene citrate is an effective and safe option for clomiphene-resistant women with PCOS.
authors.affiliation: Reproductive Medicine Unit, Department of Clinical Biochemistry, Department of Biostatistics and Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Susan Shanti
authors.initials: SS
authors.lastname: George
authors.forename: Korula
authors.initials: K
authors.lastname: George
authors.forename: Christina
authors.initials: C
authors.lastname: Irwin
authors.forename: Victoria
authors.initials: V
authors.lastname: Job
authors.forename: R
authors.initials: R
authors.lastname: Selvakumar
authors.forename: Visalakshi
authors.initials: V
authors.lastname: Jeyaseelan
authors.forename: M S
authors.initials: MS
authors.lastname: Seshadri
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005215:Fasting / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D007328:Insulin / Q000097:blood; D008596:Menotropins / Q000627:therapeutic use; D008598:Menstruation / Q000187:drug effects; D008687:Metformin / Q000627:therapeutic use*; D010060:Ovulation / Q000187:drug effects; D010062:Ovulation Induction; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D018873:Pregnancy Rate
chemical_list: D005300:Fertility Agents, Female; D007328:Insulin; D002996:Clomiphene; D008596:Menotropins; D008687:Metformin