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    Studies evaluating the use of Metformin in combination with Clomiphene Citrate resistant patients with PCOS compared to placebo. Outcomes assessed were ovulation rate, pregnancy by ultrasound, Sex Hormone Binding Globulin (SHBG), BMI, fasting insulin and testosterone levels. In total 40 citations were identified however only four were eligible for analysis. Two studies were found to have a statistically significant improvement in ovulation and pregnancy rates in the intervention group compared to the control group. These studies used the highest dose of Metformin and Clomiphene Citrate. In two studies we found statistically significant reductions in testosterone concentrations and BMI values. Metformin and Clomiphene Citrate have been shown to improve ovulation and pregnancy rates in the treatment of infertile patients with PCOS who are Clomiphene resistant. Legro RS, Barnhart HX, Schlaff WD, et al, for the Cooperative Multicenter Reproductive Medicine Network. Legro and colleagues also report a reassuringly low multiple-pregnancy rate in the treatment groups that included clomiphene citrate, and no multiples in the metformin-only group. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. In addition, they demonstrate a clear, deleterious effect of extreme obesity (body mass index [BMI] greater than 35) on the efficacy of clomiphene and metformin individually and of the 2 agents combined. Randolph, Jr, MDProfessor of Obstetrics and Gynecology, Director of the Division of Reproductive Endocrinology and Infertility, and Director of the Fellowship in Reproductive Endocrinology and Infertility, University of Michigan Health System, Ann Arbor, Mich. It is reminiscent of the Women’s Health Initiative, in that a well-designed large clinical trial has yielded findings opposite those theorized by investigators. Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. This new report by Legro and colleagues from the Cooperative Multicenter Reproductive Medicine Network resoundingly contradicts that more limited report and reasserts the primacy of clomiphene in ovulation induction for PCOS. noted comparable ovulation rates and improved conception rates when metformin was given. It is worth noting that the trial by Legro and colleagues contrasts the study by Palomba and associates in 2 critical design characteristics. First, Palomba and associates included only women with a BMI less than 30, whereas Legro and colleagues included a range of body sizes: Only 30% of participants were less than obese and nearly half were massively obese.

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    In order to use Medscape, your browser must be set to accept cookies delivered by the Medscape site. Medscape uses cookies to customize the site based on the information we collect at registration. The cookies contain no personally identifiable information and have no effect once you leave the Medscape site. This content has not been reviewed within the past year and may not represent Web MD's most up-to-date information. To find the most current information, please enter your topic of interest into our search box. 7, 2007 -- One of the oldest treatments for a common cause of infertility is still the best treatment, according to findings from a study that experts say will have a major impact on clinical practice. The drug metformin for the treatment of polycystic ovary syndrome (PCOS)-related infertility. Metformin has become the leading treatment for PCOS, despite the fact that it has not been approved for this purpose and had not been rigorously studied in infertile patients with the disorder until now. One brand name of metformin is Glucophage; researchers in the study used Glucophage XR -- an extended release form of the drug. “The findings are unequivocal,” National Institute of Child Health and Human Development program director Tracy Rankin tells Web MD. Experts agree that the large, government-funded study proves that clomiphene is the best first-line treatment for PCOS-related infertility. “Metformin has been used off label for years in the treatment of these patients, based largely on anecdotal evidence that it works.” Polycystic ovary syndrome is a leading cause of infertility. Some studies suggest that it is the most common cause of female infertility.

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