title: Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction, achievement of pregnancy, and live birth in Asian women with polycystic ovary syndrome: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the first-line medication to be used in anovulatory patients with polycystic ovary syndrome (PCOS) for ovulation induction and pregnancy achievement.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Infertility unit of a public hospital.
  
  
  METHODS
  One hundred fifteen newly diagnosed patients with PCOS based on ESHRE/ASRM criteria.
  
  
  METHODS
  These patients were assigned to three groups: group 1 (38 patients) received 500 mg of metformin three times a day; group 2 (39 patients) received clomiphene citrate (CC) at an incremental dose; group 3 (38 patients) received both medications.
  
  
  METHODS
  Rates of ovulation, pregnancy (PR), and live birth.
  
  
  RESULTS
  The ovulation rate was 23.7% in the metformin group, 59% in the CC group, and 68.4% in the combination treatment group. This was translated into a similar PR and live birth rate, which were higher in the CC and combination groups compared to the metformin group (PR: 7.9%, 15.4%, and 21.1%; live birth rate: 7.9%, 15.4%, and 18.4% in metformin, CC, and combination treatment groups, respectively), although statistically the differences were not significant. There were no multiple pregnancies and the rate of spontaneous first trimester loss was similar to the general population.
  
  
  CONCLUSIONS
  Clomiphene citrate should be the first-line treatment for ovulation induction in anovulatory patients with PCOS.
authors.affiliation: Department of Obstetric and Gynaecology, Alor Setar Hospital, Kedah, Malaysia. murizahz@hotmail.com
authors.forename: Murizah Mohd
authors.initials: MM
authors.lastname: Zain
authors.forename: Ridzuan
authors.initials: R
authors.lastname: Jamaluddin
authors.forename: Adibah
authors.initials: A
authors.lastname: Ibrahim
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Norman
mesh_terms: D000328:Adult; D000858:Anovulation / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D044466:Asian People; D002996:Clomiphene / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D006801:Humans; D007247:Infertility, Female / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D008687:Metformin / Q000627:therapeutic use*; D010060:Ovulation / Q000187:drug effects* / Q000208:ethnology; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene; D008687:Metformin