Clomiphene citrate versus metformin as first-line approach for the treatment of anovulation in infertile patients with polycystic ovary syndrome.
BACKGROUND
Clomiphene citrate (CC) and metformin are two effective drugs used to induce ovulation in patients with polycystic ovary syndrome (PCOS), even if it is still unclear which compound between them should be initially administered.


OBJECTIVE
The aim of the study was to compare in a clinical setting the efficacy of CC and metformin as first-line approaches for treating anovulation in infertile PCOS patients.


METHODS
This study was a multicenter, nonrandomized, prospective, controlled study.


METHODS
The study was conducted at the Department of Obstetrics and Gynecology, Universities "Magna Graecia" of Catanzaro and "Federico II" of Naples, Italy.


METHODS
Patients included 80 infertile anovulatory patients with PCOS allocated in two body mass index- and age-matched groups (experimental and control groups).


METHODS
Six months of 1700 mg/d metformin treatment (experimental group) or CC was administered using a traditional incremental-dose protocol (control group). In both groups, patients who ovulated under treatment continued the therapy for a total of 6 months.


METHODS
Reproductive outcomes were measured.


RESULTS
Experimental and control groups were studied for a total of 204 and 169 cycles, respectively. No difference between the two groups was observed in ovulation (55.4 vs. 59.8%, respectively; P = 0.396), pregnancy (10.8 vs. 11.2%, respectively; P = 0.888), and abortion (19.5 vs. 26.3%, respectively; P = 0.530) rates. The cumulative pregnancy rate was not different between groups (62.9 vs. 48.6%, respectively; P = 0.225).


CONCLUSIONS
A 6-month course of 1700 mg/d metformin treatment and CC administered in an escalation protocol are two effective first-line approaches for improving fertility in anovulatory PCOS women.
Palomba
Stefano
S
Department of Gynecology and Obstetrics, University Magna Graecia of Catanzaro, Via Pio X, 88100 Catanzaro, Italy. stefanopalomba@tin.it
Orio
Francesco
F
Falbo
Angela
A
Russo
Tiziana
T
Tolino
Achille
A
Zullo
Fulvio
F
D000328:Adult; D000858:Anovulation / Q000188:drug therapy*; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D008597:Menstrual Cycle / Q000187:drug effects; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome
D005300:Fertility Agents, Female; D002996:Clomiphene; D008687:Metformin