Three Therapeutic Methods for Polycystic Ovarian Syndrome

Document Type : Original Article

Authors

1 Associat Professor of Gynecology, Women Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Assistant Professor of Gynecology, Women Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Resident of of Gynecology, Women Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Assistant Professor of Biostatics, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: About 10-15% of women in the reproductive ages suffer from infertility. The most common cause of infertility with female factor is ovulation disorders (35-40%) and among them polycystic ovary syndrome (PCOS) is the most common. These patients suffer from insulin resistance, obesity and increase in androgens; many recent studies have focused on the effects of insulin sensitizing agents like metformine on the patients with PCOS. The aim of this study was to evaluate the efficacy of the three therapeutic methods of clomiphen citrate (CC), metformine and clomiphen citrate plus metformine on infertile women with PCOS.
 
Materials and Methods: This clinical trial study performed in the year 2004 at Montaserie Hospital of Mashhad University of Medical Sciences, on three groups of 20 PCOS Patients. This study was approved by the local committee of medical ethics. The women in the first group were treated with clomiphen citrate, the second group with metformine and the third group with clomiphen plus metformine for 3 months. Data were analyzed by SPSS software, by using t-student and c2. p£0.05 was statistically significant.
 
Results:Over all twenty nine (48.3%) of women conceived, with the highest rate (%70) belonging to the group treated with clomiphen citrate plus metformine (group three). There was a significant difference comparing to the other two groups (p=0.028). This finding was even more significant in the cases with high levels of serum testosterone and hirsutism.
Conclusion: Combination of metfomine plus clomiphen citrate significantly improves ovulation and pregnancy rates in patients with PCOS.
 

Keywords


1. Yawn  Shust Novak’s Gynecology 13th ed. Philadelphia: Lippincott william’s & willkins; 2002.
P.876 –885, 996-1001.
2. Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility. 6th ed.
Philadelphia: Lipincott; 2005. P.465-490
3. Gardner DK, Howks CM, Weissmann A. Textbook of assisted reproductive techniques. 2nd ed.
Florence: Toms; 2002. P.429-39.
4. Seal FG, Robinson RD, Neal GS. Association of metformin and pregnancy in the polycystic ovary
syndrom. J Repord Med 2000;45 :507-10.
5. Heard. Pregnancies with metfomrin on PCOS. fertil and stril 2002 April ; 4 :668-73.
6. Bailey CJ, Turner RC. Metformin drug therapy. N Engl J Med 1996 ; 334:574-579.
7. Batukan C, Baysal B. Metformin improves ovulation and pregnancy rates in patients with poly-cystic
ovary syndrome. Arch Gynecol Obstet 2001; 265:124-127.
8. Vandermolen DT, Ratts VS, Evons WS , Stovall DW , Kauma SW, Nestler SE. Metformin increases
the ovulatory rate and pregnancy rate from clomiphen citrat in patients with polycystic ovary
syndrome who are resistant to climiphene citrate alone. Fertil Steril 2001 Feb; 75(2):310-5.
9. Franks S. Polycystic ovary syndrome. N Engl J Med; 1995;333:853-861.
10. Diamanti E, Kndanalis E, Kouli C, Banateli T, Bergiele A. Therapeutic effects of metformin on
insulin resistance and hyperandrogenism in PCOS. Eur J Endocrinol 1998; 138:269-74.
11. Dunaif A,Xia J, Book CB, Schenker E, Tang Z. Exces sive insulin receptor serine phosphorylation in
cultured fibroblasts and in skeletal muscle. A potenital mechanism for insulin resistance in the
polycystic. J Clin Invest 1995; 96;801-810.
12. George SS, Georgc K, Trwin C, Selvakumar R, Jecya seelan V, Seshadri MS. Sequential treatment of
metformin and clomiphene citrate in climiphene resistant women with polyc sovary syndrome. Hum
Reprod 2003 Feb ; 18(2):299-304.
13. Kocak M, Caliskan E, Simsir C, Haberal A. Metformin therapy improves ovulatory rates , cervical
scores and pregnancy rates in clomiphen citrate – resistant women with polycystic ovary syndrome.
Fertil steril 2002 Jan; 77(1):101-6.
14. Nestler JE, Strauss JF. Insulin as an effector of human ovarian and adrenal steroid metabolism.
Endocrinol Metab Clin North Am 1991; (20):807-823.
15. Yarali M, Yildiz BO , Demirol A, Zeynecloglu HB, Yigit N, Bukulmez O, et al. co administration of
metformin during r FSH treatment in patients with clomiphen citrate resistant polycystic ovary
syndrom. Hum reprod 2002 Feb; 17(2):289-94.
16. Sturrok ND, Lannon B, Fay TN. Metformin does not enhanc ovulation induction in climiphene
resistant polycystic ovary syndrome in clinical practice. Br J Clin pharmacol 2002 May ;53(5) :469-
73.
17. Palomba J, Orio F Jr, Falbo A, Manguso F, Russo T, Cascella T, et al. Comparing clomiphene citrate
and metformin as the first line treatment for ovulation in duction in non obese anovulatory women
with polycystic ovary syndrome. J clin Endocrinol Metab 2005 Jul; 90(7):4068-74. 
 
18. Polson DW, Kiddey DS, Mason HD. Induction of ovulation with clomiphene citrate in women with
polycystic ovary syndrome: the difference between responders and nonresponders. Fertil steril 1989;
51: 30-34.
19. Moran C, Carranza – Lira S, Noyola JE, Garcia –Hernandez E, Henao G, Bermudez. JA Effect of
clompiphene citrate on ovulation after treatment withdrawal. Arch Gynecol Obstet 1998; 261:117-
120.
20. Malkawi HY. Oublan HS. The effect of metforminplus clomiphene citrate on ovulation and
pregnancy rates in clomphen resistant women with polycystic ovary syndrome. Saudi Med J 2002
Jun; 23(6):663-6.
21. Raja A, Hashmi SN , Sultana N, Rashid H. Presentation of polycystic ovary syndrome and its
manangement with clomiphene alone and in combination with metformin. J Ayub med coll
Abbottabad 2005 Apr –Jun;17(2):50-3.
22. Parsanezhad ME, Alborzi S, Zarei A, Dchbashi S, Omrani G. Insulin tesistant in clomiphene
responders with polycystic ovarian disease and therapeutic effec of metformin. Int J Gynaecol obstet
2001 Oct ;7521: 43-5.