EJMS

Abstract

The aim of this study is to evaluate the effect of Metformin (MET) therapy on menstrual pattern, pregnancy rates and insulin resistance in clomiphene-citrate (CC) resistant women with polycystic ovary syndrome (POCS). Insulin resistance and its compensatory hyperinsulinemia play a major pathogenic role in the infertility due to polycystic ovary syndrome (PCOS). Metformin is an insulin-sensitizing drug that can be used to induce ovulation in PCOS with enhancement of pregnancy rates and regulation of menstrual cycle. Our study includes two hundred women with CC-resistant PCOS, randomly allocated to Metformin therapy or usual treatment. Hundred patients received oral metformin therapy (500 mg, twice daily) over a period of two cycles and clomiphene citrate (150mg/ day) from the first to the fifth day of the cycle. The other 100 patients received clomiphene only (50-100mg daily for 5 days) for three cycles. There were no differences between the two groups in terms of age, BMI and duration of infertility. The primary outcomes were restoration of spontaneous menses, ovulation induction (spontaneous or clomiphene induced) and pregnancy. The endocrine profile of both groups at baseline was similar in terms treatment, CC+MET group showed a significant decrease in LH (P<0.001) total testosterone (P<0.05) and fasting insulin levels (P<0.001). Also, there were significant increase in ovulatory rate (P<0.001) pregnancy rate (P<0.001) and regularity of menstrual cycle (P<0.05) in the group of CC+MET when compared to the group of CC only. Metformin therapy not only decreases hyperandrogenism and insulin resistance but also improve ovulation rates and pregnancy rates in clomiphene citrate- resistant women with PCOS.