Metformin is a reasonable first-line treatment option for non-obese women with infertility related to anovulatory polycystic ovary syndrome - A meta-analysis of randomised trials

BACKGROUND: There are differences in opinion as to whether metformin should play a role in the primary treatment of anovulatory infertility for women with polycystic ovary syndrome (PCOS). AIM: The aim of this study was to ascertain the best available evidence comparing metformin versus clomiphene treatment for non-obese women with anovulatory infertility related to PCOS. METHODS: Meta-analysis of available data from randomised controlled trials that examined metformin versus clomiphene for the subgroup of women in the lower body mass index (BMI) range (primarily non-obese). Primary outcomes were clinical pregnancy and live birth. RESULTS: For women with BMI ≤ 30-32 kg/m2 , clinical pregnancy rates were 36.7% (52/142) for metformin and 35.7% (51/143) for clomiphene; live birth rates were 30.3% (43/142) for metformin and 30.8% (44/143) for clomiphene. CONCLUSION: The available randomised trial data show no significant difference in effectiveness of metformin versus clomiphene as ovulation induction agents for non-obese women with anovulatory PCOS. Metformin and clomiphene are both suitable options for first-line treatment.