FOLLICULAR GROWTH AFTER METFORMIN TREATMENT WITH CLOMIPHENE CITRATE, OR LOW DOSE RECOMBINANT FSH IN INSULIN RESISTANT POLYCYSTIC OVARY

Objective: To study the effect of insulin sensitizcr nictformin on follicular growth and pregnancy oulocmc with clomiphene citrate or minimal stimulation by rccombinant FSH inductions that arc monitored by transvaginal ultrasound in patients with resistant polycystic ovary syndrome (PCOS).
Methods: The study included 60 patients with insulin resistant PCOs randomly allocated into two groups: Study group: (Group I) included 30 patients. They were prclrcated with Mctformin in a dose of 500 mg tablets tds and were monitored till their serum insulin and testosterone levels become normalized then ovulation induction was done by clomiphene citrate in a dose of 50-100 mg daily starling from the fifth day of the menstrual cycle for 5 days in 15 patients [group IA]. In the other 15 patients of the study group induction of ovulation was done by rccombinant FSH in a dose of 50 to 75 m iu per day strating from the 5'1' day of the menstrual cycle for a maximum of 5 days [group IB|. The follicular growth was monitored by T.V, US from day 10-14 of the menstrual cycle. The control group (group II | included 30 patients who did not receive Mctformin. Subgroup IIA: Included 15 patients in which induction of ovulalion was done by clomiphene citrate, and group IIB included 15 patients where ovulation induction was done by rccombinant FSH as in the study group, and were also monitored in the same way.
Results: Monofollicular ovulation occurred in 5% of the studied clomiphene group compared lo 6.66% in the conlrol clomiphene group; 13.33% in the studied rFSH group and 46.66% in the conlrol rFSH group had a monofollicular ovulation. Two or more mature follicles occurred in 44.3% in the conlrol clomiphene group, while 86.66% in the studied rFSH group and 33.3% in the control rFSH showed a similar response. The rale of pregnancy was 33.32% in the studied clomiphene group compared to 13.33 in the control group, while the pregnancy rate was 53.32% in the sludied rFSH group compared lo 33.33% in the control rFSH group.
Conclusion: The insulin sensitizcr Mctformin should be used as a pretrcatmcnl adjuvant therapy in the management of infertile patients wilh resistant polycystic ovary syndrome. This can improve the ovarian response as well as occurrence of pregnancy.