OBJECTIVE: To determine the first-line medication to be used in anovulatory patients with polycystic ovary syndrome (PCOS) for ovulation induction and pregnancy achievement. DESIGN: Randomized controlled trial. SETTING:Infertility unit of a public hospital. PATIENT(S): One hundred fifteen newly diagnosed patients with PCOS based on ESHRE/ASRM criteria. INTERVENTION(S): These patients were assigned to three groups: group 1 (38 patients) received 500 mg of metformin three times a day; group 2 (39 patients) received clomiphene citrate (CC) at an incremental dose; group 3 (38 patients) received both medications. MAIN OUTCOME MEASURE(S): Rates of ovulation, pregnancy (PR), and live birth. RESULT(S): The ovulation rate was 23.7% in the metformin group, 59% in the CC group, and 68.4% in the combination treatment group. This was translated into a similar PR and live birth rate, which were higher in the CC and combination groups compared to the metformin group (PR: 7.9%, 15.4%, and 21.1%; live birth rate: 7.9%, 15.4%, and 18.4% in metformin, CC, and combination treatment groups, respectively), although statistically the differences were not significant. There were no multiple pregnancies and the rate of spontaneous first trimester loss was similar to the general population. CONCLUSION(S): Clomiphene citrate should be the first-line treatment for ovulation induction in anovulatory patients with PCOS.
RCT Entities:
OBJECTIVE: To determine the first-line medication to be used in anovulatory patients with polycystic ovary syndrome (PCOS) for ovulation induction and pregnancy achievement. DESIGN: Randomized controlled trial. SETTING: Infertility unit of a public hospital. PATIENT(S): One hundred fifteen newly diagnosed patients with PCOS based on ESHRE/ASRM criteria. INTERVENTION(S): These patients were assigned to three groups: group 1 (38 patients) received 500 mg of metformin three times a day; group 2 (39 patients) received clomiphene citrate (CC) at an incremental dose; group 3 (38 patients) received both medications. MAIN OUTCOME MEASURE(S): Rates of ovulation, pregnancy (PR), and live birth. RESULT(S): The ovulation rate was 23.7% in the metformin group, 59% in the CC group, and 68.4% in the combination treatment group. This was translated into a similar PR and live birth rate, which were higher in the CC and combination groups compared to the metformin group (PR: 7.9%, 15.4%, and 21.1%; live birth rate: 7.9%, 15.4%, and 18.4% in metformin, CC, and combination treatment groups, respectively), although statistically the differences were not significant. There were no multiple pregnancies and the rate of spontaneous first trimester loss was similar to the general population. CONCLUSION(S): Clomiphene citrate should be the first-line treatment for ovulation induction in anovulatory patients with PCOS.
Authors: Richard S Legro; Robert G Brzyski; Michael P Diamond; Christos Coutifaris; William D Schlaff; Peter Casson; Gregory M Christman; Hao Huang; Qingshang Yan; Ruben Alvero; Daniel J Haisenleder; Kurt T Barnhart; G Wright Bates; Rebecca Usadi; Scott Lucidi; Valerie Baker; J C Trussell; Stephen A Krawetz; Peter Snyder; Dana Ohl; Nanette Santoro; Esther Eisenberg; Heping Zhang Journal: N Engl J Med Date: 2014-07-10 Impact factor: 91.245
Authors: Mary E Rausch; Richard S Legro; Huiman X Barnhart; William D Schlaff; Bruce R Carr; Michael P Diamond; Sandra A Carson; Michael P Steinkampf; Peter G McGovern; Nicholas A Cataldo; Gabriella G Gosman; John E Nestler; Linda C Giudice; Phyllis C Leppert; Evan R Myers; Christos Coutifaris Journal: J Clin Endocrinol Metab Date: 2009-06-09 Impact factor: 5.958
Authors: Patricia T Jimenez; Antonina I Frolova; Maggie M Chi; Natalia M Grindler; Alexandra R Willcockson; Kasey A Reynolds; Quihong Zhao; Kelle H Moley Journal: Endocrinology Date: 2013-09-13 Impact factor: 4.736