title: Higher-order multiple pregnancy associated with metformin in women with polycystic ovary syndrome: two cases and review of the literature.
abstract: OBJECTIVE
  To describe the first reported cases of two women with polycystic ovary syndrome (PCOS) desirous of pregnancy who conceived trichorionic pregnancies following ovulation induction with metformin alone and metformin plus clomiphene.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Private fertility practice.
  
  
  METHODS
  Two women with polycystic ovary syndrome, one lean and one overweight, both oligoovulatory and not undertaking their first cycle of treatment.
  
  
  METHODS
  Ovulation induction by metformin alone or in combination with clomiphene
  
  
  METHODS
  Higher-order multiple pregnancy (triplet or greater).
  
  
  RESULTS
  Two cases of trichorionic pregnancy.
  
  
  CONCLUSIONS
  This is the first report of higher-order multiple pregnancies resulting from the use of either metformin alone or in combination with clomiphene. The additive effects of adjunctive treatments such as weight reduction, ovarian drilling, and clomiphene and metformin therapy may result in an increased incidence of higher-order multiple pregnancy and women need to be counseled about this risk. Further research is required to quantify the risk of this event per treatment cycle.
authors.affiliation: Greenslopes Specialist Centre, Brisbane, Queensland, Australia. feritility@optushome.com.au
authors.forename: Clare
authors.initials: C
authors.lastname: Boothroyd
authors.forename: Anusch
authors.initials: A
authors.lastname: Yazdani
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008687:Metformin / Q000009:adverse effects*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications; D011272:Pregnancy, Multiple
chemical_list: D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D002996:Clomiphene; D008687:Metformin