Skip Navigation



Hum. Reprod. Advance Access published online on September 9, 2004
Human Reproduction, doi:10.1093/humrep/deh440
© 2004 by European Society of Human Reproduction and Embryology
This Article
Right arrow FREE Full Text (PDF ) Freely available
Right arrow All Versions of this Article:
19/11/2474    most recent
deh440v1
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Kashyap, S.
Right arrow Articles by Rosenwaks, Z.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kashyap, S.
Right arrow Articles by Rosenwaks, Z.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Received February 9, 2004
Revised May 4, 2004
Accepted July 6, 2004

Article

Insulin-sensitizing agents as primary therapy for patients with polycystic ovarian syndrome

Sonya Kashyap 1*, George A. Wells 2, and Zev Rosenwaks 3

1 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Center for Reproductive Medicine, Weill Sanford Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA and Ottawa Health Research Institute (OHRI)
2 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
3 Center for Reproductive Medicine, Weill Sanford Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA

* To whom correspondence should be addressed. E-mail: sokashyap{at}ohri.ca; skashyap@ottawahospital.on.ca.


  Abstract

BACKGROUND: This paper is a systematic review of metformin versus clomiphene citrate (CC) in women with polycystic ovary syndrome (PCOS). METHODS: Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and QUality Of Reporting Of Meta-analyses (QUOROM) guidelines were followed. A systematic computerized literature search was done of seven bibliographic databases. Inclusion criteria included cohort and randomized controlled trials (RCT) of women with PCOS and the following medications: metformin versus placebo; metformin versus CC; metformin plus CC versus placebo plus CC. Rev-man 4.1 and Metaview 4.0 were used to analyse data. Relative risk (RR) estimates were presented. A {chi}2-test determined the significance of the association. Heterogeneity was determined by the Cochran Q-test. RESULTS: Metformin was 50% better than placebo for ovulation induction in infertile PCOS patients [RR 1.50; 95% confidence interval (CI) 1.13, 1.99]. Metformin was also of benefit in non-infertile (i.e. patients with PCOS who were not complaining of infertility) PCOS patients for cycle regulation compared to placebo (RR 1.45; CI 1.11, 1.90). Metformin was not of confirmed benefit versus placebo for achievement of pregnancy (RR 1.07; CI 0.20, 5.74). Metformin plus CC may be 3-4-fold superior to CC alone for ovulation induction (RR 3.04; CI 1.77, 5.24) and pregnancy (RR 3.65; CI 1.11, 11.99) in women with PCOS. CONCLUSIONS: Metformin is effective for ovulation induction and cycle regulation in this group of patients. Metformin plus CC appears to be very effective for achievement of pregnancy compared to CC alone. No RCTs directly compare metformin to CC but the need for such a trial exists.

Keywords: clomiphene citrate; insulin sensitizers; meta-analysis; metformin; polycystic ovarian syndrome.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Endocr. Rev.Home page
S. Palomba, A. Falbo, F. Zullo, and F. Orio Jr.
Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review
Endocr. Rev., February 1, 2009; 30(1): 1 - 50.
[Abstract] [Full Text] [PDF]

Home page
 Hum Reprod UpdateHome page
E. Moll, F. van der Veen, and M. van Wely
The role of metformin in polycystic ovary syndrome: a systematic review
Hum. Reprod. Update, November 1, 2007; 13(6): 527 - 537.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
S. Palomba, F. Orio Jr., A. Falbo, T. Russo, A. Tolino, and F. Zullo
Clomiphene Citrate Versus Metformin as First-Line Approach for the Treatment of Anovulation in Infertile Patients with Polycystic Ovary Syndrome
J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3498 - 3503.
[Abstract] [Full Text] [PDF]

Home page
 Hum ReprodHome page
M. F. Costello, B. Shrestha, J. Eden, N. P. Johnson, and P. Sjoblom
Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review
Hum. Reprod., May 1, 2007; 22(5): 1200 - 1209.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
H. Al-Inany and N. Johnson
Drugs for anovulatory infertility in polycystic ovary syndrome.
BMJ, June 24, 2006; 332(7556): 1461 - 1462.
[Full Text] [PDF]

Home page
 Eur J EndocrinolHome page
R. Pasquali and A. Gambineri
Insulin-sensitizing agents in polycystic ovary syndrome.
Eur. J. Endocrinol., June 1, 2006; 154(6): 763 - 775.
[Abstract] [Full Text] [PDF]

Home page
 Hum ReprodHome page
M. F. Costello, M. Chapman, and U. Conway
A systematic review and meta-analysis of randomized controlled trials on metformin co-administration during gonadotrophin ovulation induction or IVF in women with polycystic ovary syndrome
Hum. Reprod., June 1, 2006; 21(6): 1387 - 1399.
[Abstract] [Full Text] [PDF]

Home page
 Hum ReprodHome page
S. Palomba, T. Russo, F. Orio Jr, A. Falbo, F. Manguso, T. Cascella, A. Tolino, E. Carmina, A. Colao, and F. Zullo
Uterine effects of metformin administration in anovulatory women with polycystic ovary syndrome
Hum. Reprod., February 1, 2006; 21(2): 457 - 465.
[Abstract] [Full Text] [PDF]

Home page
 Hum ReprodHome page
I. E. Messinis
Ovulation induction: a mini review
Hum. Reprod., October 1, 2005; 20(10): 2688 - 2697.
[Abstract] [Full Text] [PDF]

Home page
 Hum ReprodHome page
S. Palomba, A. Falbo, F. Orio Jr, F. Manguso, T. Russo, A. Tolino, C. Annamaria, B. Dale, and F. Zullo
A randomized controlled trial evaluating metformin pre-treatment and co-administration in non-obese insulin-resistant women with polycystic ovary syndrome treated with controlled ovarian stimulation plus timed intercourse or intrauterine insemination
Hum. Reprod., October 1, 2005; 20(10): 2879 - 2886.
[Abstract] [Full Text] [PDF]

Home page
 Hum ReprodHome page
R. Homburg
Clomiphene citrate--end of an era? a mini-review
Hum. Reprod., August 1, 2005; 20(8): 2043 - 2051.
[Abstract] [Full Text] [PDF]

Home page
 J. Clin. Endocrinol. Metab.Home page
S. Palomba, F. Orio Jr., A. Falbo, F. Manguso, T. Russo, T. Cascella, A. Tolino, E. Carmina, A. Colao, and F. Zullo
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., July 1, 2005; 90(7): 4068 - 4074.
[Abstract] [Full Text] [PDF]

Home page
 Hum Reprod UpdateHome page
M.A. Checa, A. Requena, C. Salvador, R. Tur, J. Callejo, J.J. Espinos, F. Fabregues, J. Herrero, and (Reproductive Endocrinology Interest Group of the
Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome
Hum. Reprod. Update, July 1, 2005; 11(4): 375 - 390.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.