The efficacy and safety of clomiphene citrate and metformin on ovulation induction in patients suffering from anovulatory infertility

Hardik Patel, Prakruti Patel, R. K. Dikshit, Samidh Shah


Background: Ovulation disorders are an important cause of infertility. Polycystic ovarian syndrome (PCOS) comprises almost 90% cases of all ovulatory disorders. Clomiphene citrate helps to stimulate ovulation. Recently, use of metformin to treat PCOS due to its insulin sensitizing property is increasing. Hence, this study was undertaken to evaluate efficacy and safety of clomiphene citrate and its combination with metformin on ovulation induction and pregnancy outcome in the treatment of anovulatory infertility.

Methods: This study was done in patients of primary infertility due to anovulatory cycles at Civil Hospital, Ahmedabad. Patients were treated with clomiphene citrate in incremental doses from 50 to 150 mg for a period of maximum 6 menstrual cycle. In patients of anovulatory infertility with PCOS, clomiphene citrate was given along with metformin. At every visit, abdominal and pelvic examination, the size of ovarian follicle, endometrial thickness by ultrasonography was recorded. Urine pregnancy test was done once the menstruation was overdue by 9 days. Adverse drug effects, if any were noted. If patient did not conceive, then whole treatment was repeated from the next menstrual cycle.

Results: Out of 53 patients, five patients were lost to follow-up. The mean age of the enrolled patients in the study was 26.04±7.78. There were 20 patients (41.67%) with body mass index (BMI) <25 kg/m2 while 28 patients (58.33%) with BMI above 25 kg/m2. Among 21 patients who received clomiphene citrate alone in the study, 12 patients were ovulated (57.12%). Among 27 patients (PCOS) who received clomiphene with metformin, 18 patients were ovulated (66.74%). Pregnancy rate was 23.8% with clomiphene citrate alone while in PCOS patients, the pregnancy rate was 25.91%. Both clomiphene citrate and metformin were well tolerated in most of the patients.

Conclusion: Ovulation rate was significantly higher compared to pregnancy rate. We could not find any benefit of adding metformin to the standard treatment with clomiphene citrate.


Clomiphene citrate, Infertility, Metformin

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