Therapeutic Effect Of Metformin For Clomiphene-resistant Patients With Polycystic Ovary Syndrome:a Meta Analysis

Objectives To evaluate the efficacy of metformin(MTF) on clomiphene(CC)-resistant patients with polycystic ovary syndrome(PCOS).Methods We searched for published RCTs of MTF as treatment of CC-resistant PCOS in PubMed, EMBASE, Ovid, EBSCO databases and Cochrane Library,and then screened these studies under preset criteria.We evaluated the quality of included studies and extract data of comparison of ovulation rates and pregnancy rates and live birth rate. And we completed Meta-analysis using statistic software RevMan5.0.Results Totally21trials were included. Meta analysis showed that firstly,MTF monotherapy which was compared with NAC alone can increased ovulation rate(OR14.93,95%CI3.02～73.38, P<0.05); secondly,MTF combined with CC can increase ovulation rate (OR7.31,95%CI2.57～20.76, P<0.05) and pregnancy rate (OR7.93,95%CI2.45～25.63, P<0.05)in CC resistant PCOS patients, and the difference is of statistical significance;thirdly,MTF plus FSH which was compared with FSH alone led to higher pregnancy rates(OR2.20,95%CI1.02～4.74, P=0.04),but we found no evidence for positive effect on live birth rate(OR2.18,95%CI0.93～5.08, P=0.07); fourthly, comparing MTF plus LOD with LOD alone,there was no evidence of a difference in pregnancy(OR3.19,95%CI0.79～12.80, P=0.10) or live birth rate(OR1.33,95%CI0.30～5.84, P=0.71).Conclusions In CC-resistant PCOS women,there are so much advantage of MTF plus CC, such as good effect,little side effect,low cost and so on.The therapy schedule can be used on clinic widely,which is the preferred treatment option before starting with LOD or FSH.