Active substances: Clomiphene
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Three months. Eighty percent of tests, i have been using 100 mg of success rates. In a large study, 46 anovulatory obese women with PCOS who did not ovulate on metformin or placebo for 35 days were given 50 mg of CC daily for 5 days while continuing metformin or placebo.
Of those on metformin, 19 of 21 ovulated compared with two of 25 on placebo Nestler et al. The evidence is so far encouraging concerning the efficiency and safety of metformin as a single agent or in combination with CC for induction of ovulation in women with hyperinsulinaemic PCOS Homburg,.
In addition, metformin seem to be safe when continued throughout pregnancy, having no increase in congenital abnormalities, teratogenicity or adverse effect on infant development Glueck et al.
Preliminary data even suggest that this strategy can significantly decrease the high miscarriage rate usually associated with PCOS and reduce the incidence of gestational diabetes, pre-eclampsia and fetal macrosomia Glueck et al.
The apparent lack of teratogenicity of metformin has earned it a B classification and, hopefully, these apparently beneficial effects of metformin given throughout pregnancy will be confirmed by future studies.
The glitazones, notably rosiglitazone and pioglitazone, which also have the property of lowering insulin concentrations, are also under investigation for similar indications. A positive effect for rosiglitazone when used alone and more so when combined with CC was demonstrated for ovulation induction in women with PCOS Ghazeeri et al.
In women with PCOS but normal insulin sensitivity, metformin proved more efficient than rosiglitazone in restoring ovulation Baillargeon et al.
Aromatase inhibitors are non-steroidal compounds that suppress estrogen biosynthesis by blocking the action of the enzyme aromatase which converts androstenedione and testosterone to estrogens. Letrozole, the most widely used aromatase inhibitor, has mainly been employed for the treatment of post-menopausal women with advanced breast cancer.
It is given orally in a dose of 2. It has been hypothesized, in particular by Mitwally and Casper, that the efficient estrogen-lowering properties of the aromatase inhibitors could be utilized to temporarily release the hypothalamus from the negative feedback effect of estrogen so inducing an increased discharge of FSH.
Although the final pathway, the sought-after discharge of FSH, is common to both aromatase inhibitors and CC, their mechanism of action is obviously very different and this would seem to confer several advantages to aromatase inhibitors for the induction of ovulation.
Unlike CC, which blockades and depletes estrogen receptors, aromatase inhibitors have no effect on estrogen receptors.