PCOS Case Study
A 28-year-old woman with a history of irregular periods was referred to Penn Fertility Care by her Ob/Gyn complaining of 2 years of infertility. Initial evaluation showed the patient to have a body mass index (BMI) of 29, a slight increase in hair growth and an otherwise normal examination. Laboratory evaluation indicated slightly elevated testosterone and a pelvic ultrasound showed ovaries with multiple small cysts. A hysterosalpingogram test showed a normally shaped uterus and fallopian tubes. Her partner’s semen had been analyzed and was normal. On the basis of these findings, the
patient was diagnosed with polycystic ovary syndrome (PCOS).
Traditionally, patients with PCOS would be treated with a clomiphene citrate. However, studies in recent years suggest that metformin, prescribed alone or in combination with clomiphene, increases the ovulation rate in PCOS patients. Most PCOS patients have been prompted to take metformin––despite a lack of appropriate pregnancy and birth rate data on the drug.
This patient subsequently enrolled in a clinical trial at Penn Fertility Care with the aim of evaluating birth rates in PCOS patients treated with clomiphene citrate alone or in combination with metformin.
Penn Fertility Care took part in the largest clinical trial to date to
evaluate clomiphene citrate, metformin and the combination for their capacity
to achieve successful birth in PCOS patients.
Published in the New England Journal of Medicine*, the trial demonstrated that women treated with clomiphene citrate were three times more likely to have live births than women treated with metformin alone. Most importantly, the addition of metformin did not significantly increase the pregnancy or birth rates achieved with clomiphene alone, challenging
the current practice of using both drugs. These findings support the use of clomiphene alone as a first line therapy for ovulation induction in the treatment of infertility associated with PCOS, and reinforce its position as the standard of care for PCOS patients.
* Legro RS, Huiman X, Schlaff WD, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. N Eng J Med. 2007;356:551-566.
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