title: Pretreatment and co-administration of oral anti-diabetic agent with clomiphene citrate or rFSH for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome.
abstract: OBJECTIVE
  The objective of this study was to explore the result of pretreatment and concomitant use of metformin with clomiphene citrate (CC) and rFSH for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome (PCOS).
  
  
  METHODS
  This randomized controlled trial was done in the Dhaka Medical College and Hospital and the Infertility Care and Research Centre, Dhaka, Bangladesh. A total of 165 infertile patients with CC-resistant PCOS who attended for treatment were the target population for this study. Patients were divided into three groups: groups A and B were given metformin and group C was the control. Along with metformin, group A received CC and group B received rFSH. Group C was treated with only rFSH. Metformin was given 1500 mg daily for 4 weeks. Afterwards CC or rFSH were added for induction of ovulation along with metformin. Six ovulatory cycles were assessed. Treatment was terminated when there was no response with maximum dose of CC and rFSH or after six ovulatory cycles without pregnancy or after achieving pregnancy. A P-value of <0.5 was considered as significant.
  
  
  RESULTS
  Ovulation (89.09%) and pregnancy (54.55%) rates were higher in group B. Ovulation (74.55%) and pregnancy (29.09%) rates were also satisfactory in group C but a dose of rFSH requirement was significantly higher (P = 0.000). In group A, both ovulation and pregnancy rate were much lower than the other two groups (27.27% and 12.73%, respectively).
  
  
  CONCLUSIONS
  Use of metformin increases the response of ovulation-inducing agents and can be used safely in PCOS.
authors: Anwer Khan Modern Medical College (AKMMC), Dhaka, Bangladesh.
authors: Mosammat Rashida
authors: MR
authors: Begum
authors: Sayeba
authors: S
authors: Akhter
authors: Mariya
authors: M
authors: Ehsan
authors: Mosammat Shahina
authors: MS
authors: Begum
authors: Farzana
authors: F
authors: Khan
mesh_terms: D000328:Adult; D002996:Clomiphene / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D004965:Estrogen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D043373:Follicle Stimulating Hormone, Human / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control; D007333:Insulin Resistance; D010053:Ovary / Q000187:drug effects* / Q000503:physiopathology; D010062:Ovulation Induction / Q000009:adverse effects; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D004965:Estrogen Antagonists; D005300:Fertility Agents, Female; D043373:Follicle Stimulating Hormone, Human; D007004:Hypoglycemic Agents; D011994:Recombinant Proteins; D002996:Clomiphene