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Abstract
Clomiphene citrate (CC) is currently the first-line therapeutic modality for women with infertility and PCOS. Ovulation occurs in 70%–85% of women, but 33%–45% achieve pregnancy. (7)
If CC does result in ovulation, the American College of Obstetricians and Gynecologists recommends the use of the insulin sensitizer metformin and CC regardless of whether there is insulin resistance or not. (8)
Other insulin sensitizers from the thiazolidenediones family, namely troglitazone, piogiltazone, and rosiglitazone, have been used effectively in women with PCOS. (9), (10), (11), (12)
Recently, the American Society for Reproductive Medicine concluded that “based on the clinical evidence to date, the use of novel insulin sensitizers such as biguanides and thiazolidenediones promise new treatment options for PCOS for both fertility and long-term disease prevention”. (13)
The largest published experience with insulin sensitizers in PCOS women has been with metformin. It is a second generation biguanide used clinically in many different parts of the world to treat type 2 diabetes mellitus. (14) The most common complaint with metformin is gastrointestinal symptoms including diarrhea, nausea, vomiting, and abdominal bloating. Lactic acidosis is a rare risk among patients taking this medication. This most commonly occurs in poorly controlled diabetes and impaired renal function.