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Clinical Question:
Is metformin (Glucophage, Metforal) more effective than clomiphene (Clomid,
Serophene) for improving fertility in nonobese women with polycystic ovary
syndrome?
Bottom Line:
In nonobese women with polycystic ovary syndrome, metformin is more
effective than clomiphene for improving the rate of conception.
Reference:
Palomba S, Orio F Jr, Falbo A, et al. Prospective parallel randomized,
double-blind, double-dummy controlled clinical trial comparing clomiphene
citrate and metformin as the first-line treatment for ovulation induction in
nonobese anovulatory women with polycystic ovary syndrome. J Clin Endocrinol
Metab 2005; 90:4068-74.
Study Design:
Randomized controlled trial (double-blinded)
Setting:
Outpatient (any)
Synopsis:
Metformin (Glucophage, Metforal) and clomiphene (Clomid, Serophene) have
each been used to increase fertility in women with polycystic ovary
syndrome: This is the first study to evaluate them head-to-head. One hundred
women between the ages of 20 and 34 years with a body mass index of less
than 30 were randomly assigned (masked allocation) to receive metformin 850
mg twice daily or clomiphene 150 mg 3 times daily. Each patient also
received placebos of the opposite drug. Before starting the medications, the
patients received a progesterone challenge, and medication was then started
on the third day of progesterone-induced menstruation. The main outcome,
pregnancy rate, was assessed via intention to treat. Five patients receiving
metformin and 3 receiving clomiphene dropped out and weren't included in the
analysis. At the end of 6 months of treatment, 31 patients (69%) taking
metformin became pregnant compared with 16 (34%) taking clomiphene. If all
the patients lost to follow-up in the clomiphene group became pregnant and
none of those taking metformin did, the pregnancy rate would still be
significantly higher with metformin. We would need to treat 3 women with
metformin instead of clomiphene for 6 months for 1 additional woman to
become pregnant (95% CI, 1.9 - 6.9). The rate of side effects was similar in
each group (approximately 20%) and 1 patient in each group dropped out
because of side effects.
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