Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrate in patients with polycystic ovary syndrome who are resistant to clomiphene citrate alone☆
Presented in part at the annual meeting of the American Society of Reproductive Medicine, Toronto, Ontario, Canada, September 7–10, 1999.
Received 10 May 2000; received in revised form 1 August 2000; accepted 1 August 2000.
Abstract
Objective: To determine whether metformin treatment increases the ovulation and pregnancy rates in response to clomiphene citrate (CC) in women who are resistant to CC alone.
Patient(s): Anovulatory women with the polycystic ovary syndrome (PCOS) who were resistant to CC.
Intervention(s): Participants received placebo or metformin, 500 mg three times daily, for 7 weeks. Information on reproductive steroids, gonadotropins, and oral glucose tolerance testing was obtained at baseline and after treatment. Metformin or placebo was continued and CC treatment was begun at 50 mg daily for 5 days. Serum P level ≥ 4 ng/mL was considered to indicate ovulation. With ovulation, the daily CC dose was not changed, but with anovulation it was increased by 50 mg for the next cycle. Patients completed the study when they had had six ovulatory cycles, became pregnant, or experienced anovulation while receiving 150 mg of CC.
Main Outcome Measure(s): Ovulation and pregnancy rates.
Result(s): In the metformin and placebo groups, 9 of 12 participants (75%) and 4 of 15 participants (27%) ovulated, and 6 of 11 participants (55%) and 1 of 14 participants (7%) conceived, respectively. Comparisons between the groups were significant.
Conclusion(s): In anovulatory women with PCOS who are resistant to CC, metformin use significantly increased the ovulation rate and pregnancy rate from CC treatment.
aMedical College of Virginia of Virginia Commonwealth University, Department of Obstetrics and Gynecology, Medical College of Virgini, Virginia Commonwealth University, Richmond, Virginia, USA
bWashington University, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, USA
cUniversity of Virginia, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
dUniversity of Virginia, Department of Internal Medicine, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
Reprint requests: David T. Vandermolen, M.D., Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center–Shreveport, Box 33932, Shreveport, Louisiana 71130 (FAX: 318-675-5670)
☆ Supported by the National Institute of Child Health and Human Development, National Institutes of Health, through cooperative agreement U54HD96008 as part of the Specialized Cooperative, and by National Institutes of Health grants M01RR00065 and M01RR0036.
ABSTRACT