From the Guidelines
Metformin should not be used as a first-line treatment for ovulation induction in women with PCOS, and instead, clomiphene citrate is recommended due to its effectiveness, as evidenced by good and consistent scientific evidence 1. When considering the use of metformin and clomid (clomiphene citrate) for infertility treatment in women with polycystic ovary syndrome (PCOS), it's essential to prioritize the most effective and safe approach.
- The American College of Obstetricians and Gynecologists (ACOG) recommends clomiphene citrate as the primary treatment for ovulation induction in women with PCOS, citing its high success rate, with about 80% of women ovulating and half of them conceiving 1.
- Metformin, on the other hand, may improve ovulation frequency, but its effects on early pregnancy are not well understood, and its use is not recommended as a first-line treatment for ovulation induction 1.
- While metformin can help improve insulin sensitivity, which may reduce androgen levels and improve ovulation rates, its use should be considered on a case-by-case basis, taking into account the individual patient's needs and medical history.
- Clomid, at a dose of 50-100 mg daily for 5 days, is a well-established treatment for ovulation induction, and its effectiveness is supported by good and consistent scientific evidence 1.
- Potential side effects of clomid include hot flashes, mood changes, or visual disturbances, and regular monitoring with ultrasounds and hormone tests is recommended during treatment to track follicle development and adjust dosing as needed.
From the Research
Metformin and Clomid
- Metformin is an insulin-sensitizing agent that has been used to treat metabolic comorbidities and improve ovarian dysfunction in women with polycystic ovary syndrome (PCOS) 2, 3.
- Studies have shown that metformin can decrease insulin resistance, reduce androgen production, and improve ovulation rates in women with PCOS 2, 3, 4.
- Clomid (clomiphene citrate) is a medication used to induce ovulation in women with PCOS, and metformin has been shown to increase the sensitivity of PCOS to clomid and improve ovulation function 4, 5.
- The combination of metformin and clomid has been found to be an effective way of treating infertility caused by PCOS with insulin resistance 4.
- A study found that metformin plus clomid resulted in a higher pregnancy rate (57%) compared to metformin alone (15%) or clomid alone (20%) 4.
Effects of Metformin on PCOS
- Metformin has been shown to reduce serum lipids, androgen, and insulin levels, and induce ovulation and regular menstrual cycles in women with PCOS 5.
- Metformin may also reduce the incidence of ovarian hyperstimulation syndrome (OHSS) in women with PCOS undergoing IVF or ICSI treatment 6.
- However, the evidence on the effect of metformin on live birth rates in women with PCOS is uncertain, and more research is needed to determine its effectiveness 6.
Clinical Use of Metformin and Clomid
- The current Endocrine Society Guidelines recommend the use of metformin during adolescence, particularly when excess body weight is present 3.
- Metformin may be used as a co-treatment during IVF or ICSI in women with PCOS, but its effectiveness in improving live birth rates is uncertain 6.
- Clomid may be used to induce ovulation in women with PCOS, and metformin may be used to increase the sensitivity of PCOS to clomid and improve ovulation function 4, 5.