Efficacy of ovulation induction with clomiphene citrate and metformin in women with polycystic ovary syndrome – Pilot study

Introduction : When other causes are excluded, polycystic ovary syndrome (PCOS) refers to a state of chronic hyperandrogenemia and anovulation. There are four basic treatment goals: to treat hirsutism and its equivalents, treat anovulation, reduce insulin resistance and possible metabolic sequelae and reduce the risk of endometrial cancer. Approach in the treatment of anovulation should be gradual - from simple to more complex methods. Aim : To determine the effectiveness of ovulation induction in women with polycystic ovary syndrome in relation to given pharmacologic therapy. Patients and methods :The study included 30 women with a PCOS diagnosis. Patients were randomized in three study groups. The first study group included patients who used clomiphene citrate 50 mg 2-7 day of the cycle, the second study group included patients who used metformin 2 x 850 mg daily, while the third group included patients who used metformin 2 x 850 mg daily and clomiphene citrate 50mg 2-7 days of the cycle. Folliculometry was performed on each patient. Results : The average number of basal antral follicles bilaterally compared between study groups is not statistically significant, F=0.220, p = 0.804. The average number of basal antral follicles bilaterally was 15.40 } 3.93. The difference in average size of follicles during the last folliculometry was not statistically significant between the study groups, F = 1.369, p = 0.271. Each induction at which the follicle size is less than 18 mm we consider a failed induction. At last measurement, patients who used clomiphene citrate and metformin had the most successful inductions. Combined use of clomiphene citrate and metformin also affected the thickness of the endometrium. Patients in the third test group had a thicker endometrium than patients from the first and second group to a degree that is statistically significant. Conclusion : If there are no problems with other factors (tubal patency, spermiogram etc.), in ovulation induction the combination of metformin and clomiphene citrate in women with polycystic ovary syndrome can be successful and achieve pregnancy.