Combined metformin and clomiphene citrate versus laparoscopic ovarian diathermy for ovulation induction in clomiphene-resistant women with polycystic ovary syndrome: a randomized controlled trial.
OBJECTIVE
To compare the effect of combined metformin and clomiphene citrate (CC) with laparoscopic ovarian diathermy (LOD) meant for ovulation induction in CC-resistant women with polycystic ovary syndrome (PCOS).


METHODS
Two-hundred and eighty-two anovulatory women with CC-resistant PCOS were selected in this randomized controlled trial. Patients (n = 138) received combined metformin-CC for up to six cycles or underwent LOD (n = 144) with six months follow up. The outcome measures were: ovulation rate, midcycle endometrial thickness, pregnancy and miscarriage rates.


RESULTS
Ovulation occurred in 386/576 cycles (67%) in the combined metformin-CC group and 381/558 cycles (68.2%) in LOD group without a significant difference between the groups. Resumption of regular menstruation was similar in both groups. A significant increase in midcycle endometrial thickness was observed in the combined metformin-CC group (9.2 ± 1.2 mm vs 7.6 ± 1.1 mm) (P < 0.05). The pregnancy rate was similar in both groups (15.4% vs 17%), and there were no statistically significant differences regarding the miscarriage rate between both groups. Four twin pregnancies occurred in the metformin-CC group. No ovarian hyperstimulation occurred in either group.


CONCLUSIONS
Combined metformin-CC and LOD are equally effective for inducing ovulation and achieving pregnancy in CC-resistant PCOS patients.
Department of Obstetrics & Gynecology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt. hatem_ah@hotmail.com
Hatem
H
Abu Hashim
Naser
N
El Lakany
Lotfy
L
Sherief
D000858:Anovulation / Q000209:etiology / Q000628:therapy; D002996:Clomiphene / Q000008:administration & dosage*; D004351:Drug Resistance; D004564:Electrocoagulation; D004717:Endometrium / Q000473:pathology; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008687:Metformin / Q000008:administration & dosage*; D010053:Ovary / Q000601:surgery*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000473:pathology; D011247:Pregnancy; D016896:Treatment Outcome
D002996:Clomiphene; D008687:Metformin