Combined pioglitazone-metformin and clomiphene citrate versus metformin and clomiphene citrate in induction of ovulation in women with clomiphene citrate-resistant polycystic ovary syndrome

Objective: To compare the efficacy of pioglitazone + metformin and clomiphene citrate (CC) with metformin and CC in women with CC-resistant polycystic ovary syndrome (PCOS). Design: Randomized clinical trial (RCT). Setting: A university teaching hospital in Cairo, Egypt. Patients: One hundred women with CC-resistant PCOS. Methods: Fifty women received pioglitazone 15 mg + metformin 850 mg once daily from the first day of the cycle for 10 days, and 50 women received metformin (500 mg three times daily). Clomiphene citrate 100 mg from the third day of the cycle for 5 days was added to each group. Treatment was continued for three cycles. Main outcome measure(s): Ovulation rate and pregnancy rate. Results: Ovulation rate was significantly higher in the pioglitazone + metformin and CC group than the metformin and CC group (69.8% versus 48.8%) (p: 0.002). Significantly higher serum E-2 on day 12 and thicker endometrium were found in the pioglitazone + metformin and CC group in the three follow up cycles. Also, cummulative pregnancy rate was significantly higher in the pioglitazone + metformin and CC group than the metformin and CC group (58% versus 34%) (P: 0.027). Conclusion: The use of pioglitazone/metformin and CC is more effective than metformin and CC as regards ovulation and pregnancy rates in anovulatory women with CC-resistant PCOS. (C) 2013 Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society.