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Infertility & Reproduction Health Center

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Clomiphene Best for PCOS Infertility

Researchers Say Clomiphene More Effective Than Metformin for Treatment of Polycystic Ovary Syndrome

Clomiphene Ovulations Better

“The message that this study sends is that metformin isn’t as good as we thought it was and it should definitely not be used as a first-line, single therapy for infertility,” Legro tells WebMD.

The researchers write that there were more multiple births among the clomiphene groups (one set of triplets and four sets of twins) than the "metformin alone" group, which had none.

Women treated with both metformin and clomiphene had higher ovulation rates than women who took either single treatment, but they did not achieve higher pregnancy or live-birth rates.

This seeming paradox shows, Legro says, that not all ovulations are created equal.

"It appears that some ovulations are better than others," he says. "Clearly, ovulation rates do not tell the whole story. Now the question becomes, 'What is it about a clomiphene ovulation that makes it better than a metformin ovulation?' I don't have an answer, but it certainly deserves more study."

And even though the decades-old infertility drug was proven more effective than the diabetes drug, Legro points out that neither treatment was particularly effective, with just over one in five women in the study giving birth.

“PCOS is a major cause of infertility, and we need new treatments that work better than the ones we have,” he says.

David S. Guzick, MD, PhD, of the University of Rochester School of Medicine, tells WebMD that many infertility specialists who have abandoned clomiphene in recent years will be surprised by the new findings.

“Clomiphene has been viewed by many as passé for the treatment of PCOS-related infertility, while metformin has increasingly been seen as the drug of choice," he says. “But this study shows that the tried and true treatment works better.”

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