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Metformin versus Clomiphene Citrate or a Combination of Both as First-Line Therapy in Afertile Anovulatory Women with PCOS

15 August 2009


Background: Clomiphene citrate has been used as first-line therapy to enhance fertility in anovulatory afertile women with or without polycystic ovarian syndrome for forty years. Women with PCOS have a higher propensity to develop metabolic syndrome and infertility. Therefore, a secondary outcome in treating anovulatory afertile women with metformin, may be to delay the development of type 2 diabetes plus induce ovulation and achievement of pregnancy.

Methods: The focus of this study was to review the current literature on all studies pertaining to the first-line treatment of anovulatory afertile women with PCOS, by comparing the clomiphene citrate to metformin to induce ovulation and achieve pregnancy. The treatments reviewed included metformin, extended release metformin, clomiphene citrate or a combination of both metformin and clomiphene citrate.

Results: Of the 5 studies published, 2 studies still considered clomiphene citrate to be superior to metformin at inducing ovulation and achieving pregnancy at 6 months, two studies considered metformin superior to clomiphene citrate and one study considered both to be acceptable first-line treatment options.

Conclusion: Clomiphene citrate should still be considered first-line therapy for the treatment of inducing ovulation and achieving pregnancy in anovulatory infertile women with PCOS. However, further randomized, blinded studies are needed to better substantiate metformin’s long term (>6 months) use and secondary benefit of decreasing the likelihood of acquiring type 2 diabetes and other sequelae.


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