title: Combined metformin and clomiphene citrate versus highly purified FSH for ovulation induction in clomiphene-resistant PCOS women: a randomised controlled trial.
abstract: OBJECTIVE
  To compare the effect of combined metformin-clomiphene citrate (CC) with highly purified urinary FSH (HP-uFSH) for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS).
  
  
  METHODS
  One-hundred fifty-three anovulatory women with CC-resistant PCOS were selected in this randomised controlled trial. Patients received combined metformin-CC (n=75, 205 cycles) or HP-uFSH (n=78, 186 cycles) for three cycles. Outcome measures were; Ovulation rate, number of growing and mature follicles, serum E2, serum P, endometrial thickness, pregnancy and miscarriage rates.
  
  
  RESULTS
  The ovulation rate per cycle was significantly higher in the HP-uFSH group (83.8% vs. 62%, p=0.01). The number of follicles ≥ 12 mm ≥ 14 mm and ≥ 18 mm on the hCG day was significantly greater in the HP-uFSH group (p=0.01, p=0.02 and p=0.03, respectively). Pregnancy occurred in 23/205 cycles (11.2%) in combined metformin-CC group and 40/186 cycles (21.5%) in the HP-uFSH group; the difference was statistically significant (p=0.02). Two patients in the HP-uFSH group suffered mild OHSS.
  
  
  CONCLUSIONS
  Combined metformin-CC resulted in modest ovulation and pregnancy rates without side effects. It is logical to offer this first for CC-resistant PCOS women before resorting to more expensive alternatives especially in developing communities where economic aspects of therapy are important.
authors.affiliation: Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt. hatem_ah@hotmail.com
authors.forename: Hatem
authors.initials: H
authors.lastname: Abu Hashim
authors.forename: Alaa
authors.initials: A
authors.lastname: Wafa
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Rakhawy
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002996:Clomiphene / Q000008:administration & dosage*; D004351:Drug Resistance; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008687:Metformin / Q000008:administration & dosage*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D002996:Clomiphene; D005640:Follicle Stimulating Hormone; D008687:Metformin