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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. 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