Active substances: Clomiphene
Laboratory values that were part of the inclusion criteria included LH: FSH, serum prolactin, serum testosterone, serum insulin levels, and random blood sugar.
All subjects also underwent a transvaginal scan. Subjects underwent clinical reassessment every three months, and compliance was ensured by providing education to the patients regarding the use of metformin at every follow-up visit.
Final assessment was completed after two years, all laboratory values were re-drawn for comparison and transvaginal scan was repeated. The results of this study showed improvement in all laboratory values after two years on metformin, it also showed that metformin helped with weight reduction with an average weight loss of 4.
Wagan et al.
Subjects were started on a dose of 250 mg metformin daily, and then increased gradually to 500 mg three times a day. Patients were also included to follow a healthy diet and to exercise regularly.
This study was reassessed after six months and in subjects who had failed to conceive on clomiphene citrate Clomid was added for three cycles.
Of the sixty-three patients in the study,10 conceived within six months and 20 conceived within one year with 13 remaining infertile.
As a result of these findings, this study concluded that metformin therapy significantly increased the ovulation and conception rate.
This study concluded that metformin led to reduction of ovarian volume, as well as hyperandrogenemia in women with clinical PCOS.
These findings are in agreement with those of Qureshi et al. They went on to determine that metformin is successful in treatment of PCOS in adjunct with lifestyle adjustments such as diet and exercise in overweight and obese patients Qureshi et al.
They went on to conclude that metformin especially seems to benefit obese women with PCOS who have received three months of pre-treatment with metformin, and works in combination with other fertility drugs unspecified in inducing ovulation.
Richard S Legro et al. The systematic review conducted by Kollmann et al. Secondary outcomes were clinical pregnancy and miscarriage rates. They concluded that there is low-quality evidence pointing to a benefit of metformin supplementation on clinical pregnancy and live birth rates.
They concluded that insulin-sensitizing drugs induce beneficial effects in insulin resistance and menstrual cycle, but only metformin aided in reducing hyperandrogenemia in women with PCOS.
Metformin and Clomiphene citrate Another topic that is explored in the literature is that of using metformin combined with clomiphene citrate, better known as Clomid, for ovulation induction in women with PCOS.
Knowing that metformin and clomid could each successfully induce ovulation in anovulatory women on their own prompted many to research the effects of using the two drugs simultaneously for peak results.
Palomba et al. Clomid remains the most used medication for inducing ovulation in anovulatory women.