Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/74451
Citations
Scopus Web of Science® Altmetric
?
?
Type: Journal article
Title: Metformin versus clomiphene citrate for infertility in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis
Author: Misso, M.
Costello, M.
Garrubba, M.
Wong, J.
Hart, R.
Rombauts, L.
Melder, A.
Norman, R.
Teede, H.
Citation: Human Reproduction Update, 2012; 19(1):2-11
Publisher: Oxford Univ Press
Issue Date: 2012
ISSN: 1355-4786
1460-2369
Organisation: Robinson Institute
Statement of
Responsibility: 
Marie L. Misso, Michael F. Costello, Marie Garrubba, Jennifer Wong, Roger Hart, Luk Rombauts, Angela M. Melder, Robert J. Norman and Helena J. Teede
Abstract: BACKGROUND: Recent studies suggest that metformin may be more effective in women with polycystic ovary syndrome (PCOS) who are non-obese. The objective here is to determine and compare the effectiveness of metformin and clomiphene citrate for improving fertility outcomes in women with PCOS and a BMI, 32 kg/m2 (BMI 32 kg/m2 was used to allow for international differences in BMI values which determine access to infertility therapy through the public health system). METHODS: Databases were searched for English language articles until July 2011. 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/m2, 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/m2. 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.
Keywords: Humans
Polycystic Ovary Syndrome
Infertility, Female
Obesity
Metformin
Clomiphene
Fertility Agents, Female
Hypoglycemic Agents
Body Mass Index
Ovulation Induction
Pregnancy Rate
Ovulation
Pregnancy
Female
Live Birth
Randomized Controlled Trials as Topic
Rights: © The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
DOI: 10.1093/humupd/dms036
Appears in Collections:Aurora harvest
Obstetrics and Gynaecology publications

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.