Metformin in therapy naive patients with polycystic ovary syndrome.

Metformin in therapy naı¨ve patients with polycystic ovary syndrome Sir, We have read with great interest the paper by Moll et al. (2007) recently published on Human Reproduction Update. The aim of this systematic review was to assess the efficacy of metformin administration in the total spectrum of treatment possibilities for polycystic ovary syndrome (PCOS) patients in terms of fertility improvement, and having as primary end-point the live-birth rate. The authors (Moll et al., 2007) concluded that clomiphene citrate (CC) is still the first choice therapy for infertile women with PCOS. To draw this conclusion, the authors evaluated eight randomized controlled trials the efficacy of the treatment on live births was assessed. In addition, if the conclusion regards therapy naive PCOS patients, the studies by Sahin et al. (2004) and Khorram et al. (2006) should be excluded since in both studies, as detailed in the materials and methods sections, a met-formin pre-treatment was administered continuously for three months (Sahin et al., 2004) or cyclically for 14 days (Khorram et al., 2006) before CC treatment. Conversely, these findings could be useful to provide clinical suggestions to drive the best strategy for administrating of both drugs. In fact, we think that for therapy naive patients it should be clarified and distinguished always between head-to-head trials comparing CC versus metformin versus metformin plus CC and studies evaluating strategy of (combined and/or sequential) drug administration. In conclusion, even if the study by Moll et al. (2007) gives an important contribution in clarifying the potential role of metformin in PCOS, definitive conclusions regarding the first therapeutic approach should be considered still lacking. References El-Biely MM, Habba M. The use of metformin to augment the induction of ovulation in obese infertile patients with polycystic ovary syndrome. Two weeks of metformin improves clomiphene citrate-induced ovulation and metabolic profiles in women with polycystic ovary syndrome. or both for infertility in the polycystic ovary syndrome. Effect of clomifene citrate plus metformin and clomifene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinical trial. The role of metformin in polycystic ovary syndrome: a systematic review. Prospective parallel randomized, double-blind, double-dummy controlled clinical trial comparing clomiphene citrate and metformin as the first-line treatment for ovulation induction in nonobese anovulatory women with polycystic ovary syndrome. Presentation of polycystic ovary syndrome and its management with clomiphene alone and in combination with metformin. The …