Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction and achievement of pregnancy in 154 women with polycystic ovary syndrome.
OBJECTIVE
To determine which first-line medication is more effective in polycystic ovary syndrome (PCOS) patients for ovulation induction and pregnancy achievement and to verify whether any patient characteristic is associated with a better response to therapy.


METHODS
Observational comparative study.


METHODS
Fertility clinic.


METHODS
One hundred fifty-four infertile women with oligomenorrhea and hyperandrogenism.


METHODS
Group 1 (56 patients) received clomiphene citrate (CC) 50 mg from days 5-9 of the cycle. Group 2 (57 patients) received 500 mg of metformin 3 times a day. Group 3 (41 patients) received both medications.


METHODS
Ovulation and pregnancy.


RESULTS
Patients receiving metformin alone had an increased ovulation rate compared with those receiving CC alone (75.4% vs. 50%). Patients on metformin had similar ovulation rates compared with those in the combination group (75.4% vs. 63.4%). Pregnancy rates were equivalent in the 3 groups. Response to metformin was independent of body weight and dose. Finally, nonsmoking predicted better ovulatory response overall as well as lower fasting glucose for CC and lower androgens for metformin.


CONCLUSIONS
Metformin is better for ovulation induction than CC alone and equivalent for pregnancy achievement. We suggest that metformin can be used first for ovulation induction in patients with PCOS regardless of their weight and insulin levels because of its efficacy and known safety profile.
Neveu
Nathalie
N
PROCREA Cliniques, Mont-Royal, Québec, Canada.
Granger
Louis
L
St-Michel
Pierre
P
Lavoie
Hélène B
HB
D000328:Adult; D002170:Canada / Q000453:epidemiology; D002996:Clomiphene / Q000008:administration & dosage*; D015897:Comorbidity; D004338:Drug Combinations; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007247:Infertility, Female / Q000188:drug therapy* / Q000453:epidemiology*; D008687:Metformin / Q000008:administration & dosage*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D016896:Treatment Outcome
D004338:Drug Combinations; D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D002996:Clomiphene; D008687:Metformin