Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction, achievement of pregnancy, and live birth in Asian women with polycystic ovary syndrome: a randomized controlled trial

Zain, Murizah Mohd; Jamaluddin, Ridzuan; Ibrahim, Adibah; Norman, Robert J.

doi:10.1016/j.fertnstert.2007.12.002

Cited by 85 publications

(76 citation statements)

References 34 publications

(37 reference statements)

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“…From the remaining 106 articles, 60 were excluded on the basis of the abstract. For the remaining 46, we obtained full manuscripts and following scrutiny of these, we identified 32 potentially relevant studies; 6 publications were duplicated [19,20,21,22,23,24]. From these 32, another 4 were excluded because they included women with PCOS who were CC resistant.…”

Section: Resultsmentioning

confidence: 99%

Is Metformin Indicated as Primary Ovulation Induction Agent in Women with PCOS? A Systematic Review and Meta-Analysis

Siebert¹,

Viola²,

Steyn³

et al. 2012

Gynecol Obstet Invest

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Background: A recent meta-analysis has proven that metformin (M) is highly effective for ovulation induction in the clomiphene citrate (CC)-resistant patient. There is uncertainty whether M should be introduced as a primary ovulation induction agent in polycystic ovarian syndrome (PCOS). Methods: We conducted a systematic review and meta-analysis to establish if M is better when given alone or in combination with CC (CC+M) when compared with CC alone. This systematic review studied live birth delivery rate as the primary outcome. Results: We identified 14 prospective trials. Analysis of these results showed a reduction in the live birth rate in the group of patients treated only with M when compared with CC alone (OR = 0.48, 95% CI 0.31–0.73, p = 0.0006). An increase in ovulation (OR = 1.6, 95% CI 1.2–2.1, p = 0.0009) and pregnancy rate (OR = 1.3, 95% CI 1.0–1.6, p = 0.05) with CC+M when compared with CC alone was reported, but no difference was found when live birth rate was analyzed (OR = 1.1, 95% CI 0.8–1.5, p = 0.61). Conclusion: CC alone is superior to M alone regarding live birth rate and ovulation. The combination (CC+M) is superior to CC alone as a primary method for ovulation induction and to achieve pregnancy in PCOS. However, when addressing live birth rate, no statistically significant difference could be demonstrated. Because of the side effects profile and contraindications of M, we believe M should not be indicated as a primary ovulation induction agent in women with PCOS.

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Section: Resultsmentioning

confidence: 99%

Is Metformin Indicated as Primary Ovulation Induction Agent in Women with PCOS? A Systematic Review and Meta-Analysis

Siebert¹,

Viola²,

Steyn³

et al. 2012

Gynecol Obstet Invest

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“…The proportion of obese patients in our study population was larger than the proportions in study populations in other countries, [19][20][21] but the mean BMI was reflective of the U.S. population of women with the polycystic ovary syndrome and nearly identical to that in our previous trial 2 and other U.S. multicenter trials, 22 despite slightly different diagnostic criteria for the polycystic ovary syndrome. There was no clear evidence that relative efficacy differed according to BMI tertile.…”

Section: Discussionmentioning

confidence: 38%

Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome

2014

N Engl J Med

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“…They concluded that CC should be used as first line therapy in these women. 22 Contrary to the study of Zain et al, Neveu et al, found nearly similar ovulation rates among PCOS females treated with metformin alone and metformin + CC group. Furthermore, conception rates were also not different in the three groups, i.e., metformin alone, CC alone, and combination group.…”

mentioning

confidence: 76%

“…[17][18][19][20] In our study, regularity of menstrual cycle was found more in patients receiving metformin along with CC, that concludes that metformin has an important role in regularization of menstrual cycle as concluded by Katsiki et al, Zain et al, and Pasquali and Gambineri. [21][22][23] A controlled trial in India carried out previously that the metformin + CC resulted in higher rate of ovulation than CC alone group (P = 0.0016). The pregnancy rate was 8% with CC and 24% with metformin + CC group.…”

mentioning

confidence: 99%

Clomiphene citrate alone versus combined metformin and clomiphene citrate versus combined metformin and clomiphene citrate and drilling versus metformin alone in infertile Indian women with PCOS: a prospective cross-sectional study

Airao

Savalia

Chaudhary

2018

Int J Reprod Contracept Obstet Gynecol

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Background: Polycystic ovary syndrome (PCOS) is a common cause of infertility and is associated with chronic anovulation and hyperandrogenemia. With associated features like irregular menses, acne and hirsuitism. It is seen in approximately 6% of women in reproductive age group and is one of the most common reproductive abnormality and endocrinopathy. Clomiphene Citrate remains the mainstay of this disorder however addition of metformin to it has been known to improve ovulation and pregnancy. The aim and objectives of the present study were to diagnose the patients with PCOS out of all patients who present with complaints of infertility, to compare ovulation and conception rates with Clomiphene Citrate alone V/S Combined Metformin and Clomiphene Citrate V/S Combined Metformin and Clomiphene Citrate and Drilling V/S metformin alone in Infertile Indian Women with PCOS. Methods: A total of 50 cases with PCOS, in women of age group between 20 to 35 years was studied from June 2017 to December 2017. All of them having chief complain of infertility. Endocrino-histologic correlation and laparoscopic evaluation was confirmed by history, clinical manifestations, USG, laboratory investigations (LH, FSH, Insulin levels etc.) and laparoscopy was done. Results: After administration of Insulin sensitizing agent, Tab. Metformin, 500mg 1 TDS, in management of PCOS who have hyperinsulinemic insulin resistance, there was ovulation with regular menstrual cycles, followed by pregnancy and full term deliveries. Thus, metformin definitely has a role in treatment of PCOS. Conclusions: Metformin down regulated the hyperstimulated reproductive axis and allows for reversal to normoandrogenic state. Hence adding metformin to CC leads to increased ovulatory and conception rates as compared to either of them alone. In cases of laproscopic ovarian drilling spontaneous pregnancy rates showed no statistically significant correlation between the degree of fall in AMH but the chances of successful conception may improve after Ovarian drilling.

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Comparison of clomiphene citrate, metformin, or the combination of both for first-line ovulation induction, achievement of pregnancy, and live birth in Asian women with polycystic ovary syndrome: a randomized controlled trial

Cited by 85 publications

References 34 publications

Is Metformin Indicated as Primary Ovulation Induction Agent in Women with PCOS? A Systematic Review and Meta-Analysis

Is Metformin Indicated as Primary Ovulation Induction Agent in Women with PCOS? A Systematic Review and Meta-Analysis

Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome

Clomiphene citrate alone versus combined metformin and clomiphene citrate versus combined metformin and clomiphene citrate and drilling versus metformin alone in infertile Indian women with PCOS: a prospective cross-sectional study

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