Polycystic Ovarian Syndrome (PCOS), Obesity, Serum Free Testosterone, Clomiphene, Metformin.


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Polycystic Ovarian Syndrome (PCOS) is a heterogeneous multifactorial disorder in which the ovarian dysfunction is the main cause of an ovulatory infertility. Metformin and Clomiphene Citrate (CC) are two effective drugs to induce ovulation in these patients. The study aimed to ascertain the effect of obesity, serum insulin and free testosterone levels on fertility success with metformin and CC as first line approaches in PCOS. This clinical study was a retrospective multicenter cohort study conducted in nine gynecology and endocrinology clinics. It included (61) PCOS women, aged (18-32) years, having desire to conceive, and free from the study medications for more than six months. Patients were divided to metformin receiving and CC receiving groups. Main outcomes of measure were; pregnancy rate, and improvement in PCOS as detected by ultrasound on their second visit. Results showed that CC was more effective in non-obese users (P0.05). Overall improvement was affected by Serum Free Testosterone (SFT) in both study groups (P>0.05). Metformin was effective regardless of patient’s SFT levels, while CC was effective in patients with high SFT levels. There was a significant association between obesity and pregnancy rate in metformin users (P0.05). However, CC was less effective than metformin in overall improvement (OR=0.53, P>0.05,) suggesting metformin as the possible drug of choice regardless to obesity, serum insulin and SFT levels.



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