Document Detail

Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis.
MedLine Citation:
PMID:  22956412     Owner:  NLM     Status:  MEDLINE    
INCLUSION CRITERIA: women of any age, ethnicity and weight with PCOS diagnosed by all current criteria, who are infertile; at least 1000 mg of any type of metformin at any frequency, including slow release and standard release, compared with any type, dose and frequency of clomiphene citrate.
OUTCOMES: rates of ovulation, live birth, pregnancy, multiple pregnancies, miscarriage, adverse events, quality of life and cost effectiveness. Data were extracted and risk of bias assessed. A random effects model was used for meta-analyses of data, using risk ratios (relative risk). RESULTS The search returned 4981 articles, 580 articles addressed metformin or clomiphene citrate and four randomized controlled trials (RCTs) comparing metformin with clomiphene citrate were included. Upon meta-analysis of the four RCTs, we were unable to detect a statistically significant difference between the two interventions for any outcome in women with PCOS and a BMI < 32 kg/m(2), owing to significant heterogeneity across the RCTs. CONCLUSIONS Owing to conflicting findings and heterogeneity across the included RCTs, there is insufficient evidence to establish a difference between metformin and clomiphene citrate in terms of ovulation, pregnancy, live birth, miscarriage and multiple pregnancy rates in women with PCOS and a BMI < 32 kg/m(2). However, a lack of superiority of one treatment is not evidence for equivalence, and further methodologically rigorous trials are required to determine whether there is a difference in effectiveness between metformin and placebo (or no treatment) or between metformin and clomiphene citrate for ovulation induction in women with PCOS who are non-obese. Until then, caution should be exercised when prescribing metformin as first line pharmacological therapy in this group of women.
Marie L Misso; Michael F Costello; Marie Garrubba; Jennifer Wong; Roger Hart; Luk Rombauts; Angela M Melder; Robert J Norman; Helena J Teede
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2012-09-06
Journal Detail:
Title:  Human reproduction update     Volume:  19     ISSN:  1460-2369     ISO Abbreviation:  Hum. Reprod. Update     Publication Date:    2013 Jan-Feb
Date Detail:
Created Date:  2012-11-29     Completed Date:  2013-09-23     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  9507614     Medline TA:  Hum Reprod Update     Country:  England    
Other Details:
Languages:  eng     Pagination:  2-11     Citation Subset:  IM    
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MeSH Terms
Body Mass Index
Clomiphene / administration & dosage*
Fertility Agents, Female / administration & dosage*
Hypoglycemic Agents / administration & dosage*
Infertility, Female / drug therapy*,  etiology
Live Birth
Metformin / administration & dosage*
Obesity / complications
Ovulation / drug effects
Ovulation Induction / methods
Polycystic Ovary Syndrome / complications*
Pregnancy Rate
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Fertility Agents, Female; 0/Hypoglycemic Agents; 1HRS458QU2/Clomiphene; 9100L32L2N/Metformin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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