Clomiphene-Metformin vs Clomiphene in Infertil Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis
Abstract
Objective: To compare the efficacy of clomiphene citrate and metformin with clomiphene citrate alone in treating primary infertility in women with polycystic ovarian syndrome.Methods: PubMed, SCOPUS, and Google Scholar databases were searched for English-language randomized controlled trials from 2015 to 2024. Inclusion criteria: reproductive age group (15 - 35 years), all ethnicities, diagnosed with PCOS by all current criteria, who are primarily infertile, and received clomiphene citrate and metformin compared to clomiphene citrate alone or with placebo. Primary outcomes: efficacy or improvement in fertility.Result: The search returned 1251 articles; 120 articles addressed metformin or clomiphene citrate, and four randomized controlled trials (RCTs) comparing metformin and clomiphene citrate with clomiphene citrate alone were included. One thousand seven hundred thirty-seven (1737) women with primary infertility and PCOS were included in this systematic review. The dose of metformin was 500 - 850mg twice or thrice daily, and the dose of clomiphene citrate was 50 - 100mg once daily. Based on four articles, the efficacy of fertility improvement of metformin and clomiphene citrate was significantly higher (231/869; 26.58%) compared to clomiphene citrate alone or with placebo (169/868; 19.47%) (OR = 1.5; 95% CI 1.10 [1.04-1.15]; p-value = 0.0004, 4 trials; I2 = 49%; n = 1737).Conclusion: Metformin and clomiphene citrate are more effective for improving fertility than…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,737 participants or records.
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