Ovulation induction in polycystic ovary syndrome- How to metformin and clomifene citrate compare?  

Oleh:

Pesant, Marie-Helene ; Baillargeon, Jean-Patrice

Jenis: Article from Bulletin/Magazine - ilmiah internasional
Dalam koleksi: Journal of Paediatrics, Obstetrics Gynecology (JPOG) vol. 33 no. 04 (Jul. 2007), page 136.

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Perpustakaan FK Nomor Panggil: J14.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background : To compare the efficacy of metformin and clomifene citrate as the first-line treatment for anovulatory infertility in polycystic ovary syndrome (PCOS) Design : That was an observational, comparative study of premenoupausal women with PCOS. Eligible participants had oligoamenorrhoea (<9 menstrual periods each year), and clinical or biochemical evidence of hypandrogenism. Patient with pelvic fertility factors or spouses with oligospermia were also included. Patients in the clomifene citrate group recieved an initial dose of 50 mg daily from days 5 to 9 of the cycle. This dose was increased by 50 mg per cycle until until ovulation was achieved. Patients in the metformin group recieved an initial dose of 250 mg, given three times daily for a week. This dose was progressively increases to 500 mg three times daily thereafter. For patient who did not achive ovulation, the dose was further increase to 1 g twice daily. Patient in the combined group received clomifene citrate 2 to 3 moths after metformin therapy was started. Result : The clomifene citrate, metformine and combined groups comprised 56,57 and 41 patients, respectively. The mean BMI at baseline was 31,4 kg/m2, and glucose tolerance abnormalities were detected in 32% of the cohort overall; however, insulin resistance was most common in the metformin group. The ovulation rate in the metformin group was higher than in the clomifene citrate and combined group (75.4% versus 50.0% and 63.4%, respectively). Ovulation in response to metformin was achived more often in patients with a BMI of 27 to 35 kg/m2 than in patients with a BMI <27 kg/m2. The efficacy of metformin was, however, independent of dose and weight loss. Pregnancy rates were similar in the three groups : clomifene citrate (35.7%), metformin (45.6%), and combined therapy (31.7%). Pregnancy occurred earlier in the clomifene citrate group than in the metformin group; however, the effects of metformin were sustained throughout the treatment period. Nonsmoking was the major predictor of ovulation response,regardless of the treatment regimen. Conclusion : Metformin was better than clomifene citrate for ovulation induction; however, there was no difference in the pregnancy rates achieved.

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