Clomiphene citrate versus metformin as first-line approach for
the treatment of anovulation in infertile patients with polycystic
ovary syndrome.
Department of Gynecology and Obstetrics,
University Magna Graecia of Catanzaro, Via Pio X, 88100 Catanzaro,
Italy. stefanopalomba@tin.it
CONTEXT: Clomiphene citrate (CC) and metformin
are two effective drugs used to induce ovulation in patients with
polycystic ovary syndrome (PCOS), even if it is still unclear
which compound between them should be initially administered.
OBJECTIVE: The aim of the study was to compare in a clinical
setting the efficacy of CC and metformin as first-line approaches
for treating anovulation in infertile PCOS patients. DESIGN: This
study was a multicenter, nonrandomized, prospective, controlled
study. SETTING: The study was conducted at the Department of
Obstetrics and Gynecology, Universities "Magna Graecia" of
Catanzaro and "Federico II" of Naples, Italy. PATIENTS: Patients
included 80 infertile anovulatory patients with PCOS allocated in
two body mass index- and age-matched groups (experimental and
control groups). INTERVENTIONS: Six months of 1700 mg/d metformin
treatment (experimental group) or CC was administered using a
traditional incremental-dose protocol (control group). In both
groups, patients who ovulated under treatment continued the
therapy for a total of 6 months. MAIN OUTCOME MEASURES:
Reproductive outcomes were measured. RESULTS: Experimental and
control groups were studied for a total of 204 and 169 cycles,
respectively. No difference between the two groups was observed in
ovulation (55.4 vs. 59.8%, respectively; P = 0.396), pregnancy
(10.8 vs. 11.2%, respectively; P = 0.888), and abortion (19.5 vs.
26.3%, respectively; P = 0.530) rates. The cumulative pregnancy
rate was not different between groups (62.9 vs. 48.6%,
respectively; P = 0.225). CONCLUSION: A 6-month course of 1700
mg/d metformin treatment and CC administered in an escalation
protocol are two effective first-line approaches for improving
fertility in anovulatory PCOS women.
PMID: 17595241 [PubMed - in process]