Bushra Qayyum, Sohail Mehmood Chaudhry, Joveria Sadaf.
Management of anovulatory infertility (polycystic ovary syndrome) with clomiphene alone and in combination with metformin.
J Surg Pak Jan ;15(3):135-8.

Objective To compare the efficacy of clomiphene alone and in combination with metformin in patients presenting with polycystic ovarian syndrome (PCOS). Study design A clinical trial. Place & Duration of study Department of obstetrics and Gynaecology, Unit II, Bahawal Victoria Hospital Bahawalpur, from October 2006 to December 2007. Methodology A total of sixty patients were included in the study and divided into two groups of thirty each fulfilling the inclusion criteria. Group A patients were given metformin 500mg thrice daily with gradually increasing dose over a period of 3 weeks to achieve actual dose and clomiphene citrate 50mg once daily for 5 days starting on 2nd day of menstrual cycle. Group B patients were given clomiphene citrate only, 50mg once daily, for 5 days starting on 2nd day of menstrual cycle. Results Menstrual regularity was found in 22 (73% ) patients in Group A compared with 13 (43%) patients in Group B. Ovulation detected by follicular tracking on ultrasonography was found in 19 (63%) patients in Group A compared with 11 (36.6%) patients in Group B. Conception confirmed on urine pregnancy test in 16 (53%) patients in Group A compared with 8 (26.6%) patients in Group B, and conception confirmed on sonographic detection of gestation sac was found in 14 (46.6%) patients in Group A compared with 8 (26.6%) patients in Group B. Conclusions A combination of metformin and clomiphene citrate significantly regulated the menstrual cycle and increased the ovulation and conception rates in the management of anovulatory infertility.

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