Two weeks of metformin improves clomiphene citrate-induced ovulation and metabolic profiles in women with polycystic ovary syndrome.
OBJECTIVE
To determine if short courses of metformin (MET) administration in patients with polycystic ovary syndrome (PCOS) would reduce fasting insulin and improve the efficacy of clomiphene citrate (CC) to induce ovulation.


METHODS
A randomized prospective trial involving 31 subjects with PCOS and infertility.


METHODS
University-based medical center.


METHODS
Obese patients (body mass index > 29 kg/m2) with PCOS.


METHODS
Patients with PCOS were treated either with CC or CC+MET for 2 weeks.


METHODS
Ovulation as determined by serum P, serum insulin, and total and free T.


RESULTS
In the CC/MET group, a significant increase in sex hormone-binding globulin (SHBG) levels, a decrease in fasting insulin, and an increase in fasting glucose/fasting insulin was detected on day 21 of the cycle. Of these parameters, only SHBG levels increased significantly in the CC group. In the CC/MET group, a significant increase in day 21 progesterone occurred, with 44% of subjects ovulating in the CC+MET group as compared with 6.7% in the CC group. Five subjects in the CC+MET group and none in the CC group conceived. Total and free testosterone levels did not change significantly for either group.


CONCLUSIONS
In obese PCOS patients, 2 weeks of MET significantly reduces serum insulin and insulin resistance and increases SHBG levels, resulting in an improved response to CC. This regimen may be beneficial in noncompliant patients or those with intolerance to the side effects of MET.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California 90502, USA. okhorram@obgyn.humc.edu
Omid
O
Khorram
Jason P
JP
Helliwell
Simone
S
Katz
Colleen M
CM
Bonpane
Lorena
L
Jaramillo
D000328:Adult; D002996:Clomiphene / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007246:Infertility / Q000097:blood / Q000188:drug therapy; D007328:Insulin / Q000097:blood; D008687:Metformin / Q000008:administration & dosage*; D009765:Obesity / Q000097:blood / Q000188:drug therapy; D010060:Ovulation / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000097:blood* / Q000188:drug therapy*; D012738:Sex Hormone-Binding Globulin / Q000032:analysis*; D016896:Treatment Outcome
D004338:Drug Combinations; D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D007328:Insulin; D012738:Sex Hormone-Binding Globulin; D002996:Clomiphene; D008687:Metformin