Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrome (original) (raw)
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Use of Metformin in Clomiphene Citrate (CC) Resistant Polycystic Ovary Syndrome (PCOS
Journal of Safog With Dvd, 2009
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting between 4% and 8% of reproductive aged women. Although the symptoms and signs of PCOS are very heterogeneous, the syndrome usually presents with any combination of the following, menstrual irregularities (usually oligomenorrhea or amenorrhea), signs of hyperandrogenism (hirsutism, acne, alopecia) a characteristic appearance of the ovaries on ultrasound examination and an endocrine disturbance often involving high serum concentrations of LH and androgens.
Human Reproduction, 2003
BACKGROUND: Recognition of the importance of insulin resistance in clomiphene-resistant women with polycystic ovary syndrome (PCOS) has led to the use of insulin sensitizers. METHODS: A randomized, controlled trial was conducted to compare ef®cacy of sequential treatment with metformin and clomiphene citrate with conventional gonadotrophins. Sixty clomiphene-resistant women with PCOS were randomized to two groups (n = 30 each), using computer-generated tables. Group I received metformin for 6 months, followed by ovulation induction with clomiphene citrate; group II received hMG for ovulation induction. Hormonal pro®les were evaluated at the onset and after completion of treatment. RESULTS: There was no signi®cant difference in pregnancy rates between the two groups (16.7 versus 23.3%). In group I, there was a signi®cant improvement in menstrual function and ovulation after treatment (40%, P < 0.001; and 46.7%, P < 0.001), with a signi®cant decrease in fasting insulin levels (P < 0.05). There were no changes in other biochemical parameters. The ovulation rate in group II was 43.3%, with a high drop-out rate. The cost-effective analysis for medications per pregnancy in group I was US$ 71 T T 3 versus US$ 277 T T 171 in group II. CONCLUSIONS: Sequential treatment with metformin and clomiphene citrate is an effective and safe option for clomiphene-resistant women with PCOS.
Fertility & Reproduction
Background: Polycystic ovary syndrome (PCOS) affects 5%-15% of women of reproductive age and has a negative impact on their fertility. The primary outcome of this study is ovulation rate when standard (immediate release) metformin (MF) is added to clomiphene citrate (CC) in oligoovulatory and anovulatory women with PCOS. Methods: This is a randomized, double-blind, placebo-controlled trial. Twenty-seven women with PCOS (according to the Rotterdam consensus), desiring pregnancy and without another cause of subfertility were recruited from a public hospital outpatient gynecology clinic. Up to six cycles of CC (25-150 mg) plus either MF 500 mg tds (CC+MF) or placebo (CC+Pl) were offered. Student’s t-test, Chi-squared test, and Fisher’s exact test were used for analysis. Results: Thirteen women with up to six cycles each were included in the final analysis. The rate of ovulation and ovulation rate per cycle was similar between women in the CC+MF and CC+Pl groups RR 1.09 (95% CI 0.80-1.4...
Journal of Obstetrics and Gynaecology Research, 2013
Aim: The objective of this study was to explore the result of pretreatment and concomitant use of metformin with clomiphene citrate (CC) and rFSH for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome (PCOS). Material and Methods: This randomized controlled trial was done in the Dhaka Medical College and Hospital and the Infertility Care and Research Centre, Dhaka, Bangladesh. A total of 165 infertile patients with CC-resistant PCOS who attended for treatment were the target population for this study. Patients were divided into three groups: groups A and B were given metformin and group C was the control. Along with metformin, group A received CC and group B received rFSH. Group C was treated with only rFSH. Metformin was given 1500 mg daily for 4 weeks. Afterwards CC or rFSH were added for induction of ovulation along with metformin. Six ovulatory cycles were assessed. Treatment was terminated when there was no response with maximum dose of CC and rFSH or after six ovulatory cycles without pregnancy or after achieving pregnancy. A P-value of <0.5 was considered as significant. Results: Ovulation (89.09%) and pregnancy (54.55%) rates were higher in group B. Ovulation (74.55%) and pregnancy (29.09%) rates were also satisfactory in group C but a dose of rFSH requirement was significantly higher (P = 0.000). In group A, both ovulation and pregnancy rate were much lower than the other two groups (27.27% and 12.73%, respectively). Conclusions: Use of metformin increases the response of ovulation-inducing agents and can be used safely in PCOS.
Status of clomiphene citrate and metformin for infertility in PCOS
Trends in Endocrinology & Metabolism, 2012
Though widely used, there is uncertainty about the effectiveness and adverse effects of metformin and clomiphene citrate (CC) for infertility in polycystic ovary syndrome (PCOS). A systematic review (SR) of the best available evidence suggests that both CC and metformin are better than placebo for increasing ovulation and pregnancy rates, but CC is more effective than metformin for ovulation, pregnancy and live-birth rates, in PCOS patients with body mass index (BMI) >30. A combination of CC and metformin is superior to either metformin alone or CC alone, depending on the BMI and CC sensitivity of the patient. This SR provides key messages to guide clinicians and consumers on the use of these interventions in different subgroups of women with PCOS.
Fertility and Sterility, 2006
To determine if short courses of metformin (MET) administration in patients with polycystic ovary syndrome (PCOS) would reduce fasting insulin and improve the efficacy of clomiphene citrate (CC) to induce ovulation. Design: A randomized prospective trial involving 31 subjects with PCOS and infertility. Setting: University-based medical center. Patient(s): Obese patients (body mass index Ͼ 29 kg/m 2 ) with PCOS. Intervention(s): Patients with PCOS were treated either with CC or CCϩMET for 2 weeks. Main Outcome Measure(s): Ovulation as determined by serum P, serum insulin, and total and free T.
To evaluate the effects of clomiphene citrate alone versus combined metformin and clomiphene citrate in patients of polycystic ovarian syndrome with anovulatory infertility in increasing ovulation and pregnancy rate. STUDY DESIGN: A Randomized controlled study. PLACE AND DURATION: The study was done at the infertility clinic of Gynaecology and Obstetrics dept of KRL hospital Islamabad for one year from 16th November, 2009 till 15th November, 2010. METHODOLOGY: 74 diagnosed patients of PCOS with anovulatory infertility were included in the study. Simple random sampling was done and 37 patients of group A were given clomiphene citrate from 50-150 mg on 2nd-6th day of menstrual cycle, for 6 cycles. The patients of group B were given Metformin 1.5 gms daily for 6 months alongwith clomiphene citrate 50-150 mg on 2nd-6th day of menstrual period, maximum 6 cycles. Ovulation was monitored by transvaginal sonography and serum progesterone level measurement which was done on 21st day of the cycle. Pregnancy was confirmed by serum B-hCG. RESULTS: CONCLUSION: The results proved that metformin along with clomiphene citrate significantly improves ovulation and pregnancy rate in patients of PCOS with anovulatory infertility and the combination of both drugs produced far better results than clomiphene citrate alone.
Indian Journal of Obstetrics and Gynecology Research, 2023
Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of women of reproductive age-group, characterised by a combination of hyperandrogenism, chronic anovulation, and polycystic ovaries. It is one of the most common cause of hyperandrogenism, hirsutism and anovulatory infertility. The aim of the study is to determine & compare the rate of ovulation, regularisation of menstrual cycle and rate of pregnancy by use of combination of Clomiphene citrate and Metformin & with use of Clomiphene citrate alone in patients with PCOS. Materials and Methods: A total 110 patients (55 in each group) having primary subfertility and diagnosed as PCOS in age group of 18 to 40 years of age, selected between April 2017-March 2018. The primary outcome i.e, incidence of ovulation was detected by folliculometry. The secondary outcomes, i.e, regularisation of menstrual cycle & Pregnancy rates were taken into account and compared in both the groups. Results: Overall ovulation was found highest at the end of 3rd cycle of ovulation induction, 48.8% and 41% respectively in each group. The Primary outcome was significantly higher in group a given combination of clomiphene citrate and metformin (83.3%) with respect to group B given clomiphene citrate only (65.9%). The secondary outcomes were significantly higher in group given CC plus metformin (89.6%). Pregnancy rates were higher in 1st group 33.3% than 2nd group (20.5%). Conclusion: In the present study one group was given combination of Clomiphene citrate with metformin and another group was given clomiphene citrate only for ovulation induction. It was found that combination of clomiphene citrate and metformin was more effective in induction of ovulation in women suffering from PCOS when compared to induction of ovulation with clomiphene citrate alone. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.