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Sponsored by: |
Wilford Hall Medical Center |
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Information provided by: | Wilford Hall Medical Center |
ClinicalTrials.gov Identifier: | NCT00413179 |
The purpose of our study was to conduct a placebo controlled, double-blind randomized trial in chronic oligoovulatory or anovulatory , hyperandrogenic, infertility patients comparing the effects of adjuvant metformin plus clomiphene citrate to clomiphene citrate plus placebo on pregnancy rates and ovulation rates. We hypothesized that combining metformin with clomiphene citrate would result in higher ovulation and pregnancy rates in hyperandrogenic women who have chronic oligoovulation or anovulation as the sole etiology for their infertility and who have unknown responsiveness to clomiphene citrate.
Condition | Intervention | Phase |
---|---|---|
Polycystic Ovary Syndrome Anovulation Oligoovulation Infertility Hyperandrogenism |
Drug: Metformin Drug: Clomiphene citrate Drug: Placebo |
Phase III |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | The Effect of Metformin Added to Clomiphene Citrate on Pregnancy Rates in Hyperandrogenic, Chronic Oligoovulatory or Anovulatory Women: A Randomized Trial |
Estimated Enrollment: | 56 |
Study Start Date: | December 1997 |
Estimated Study Completion Date: | April 2003 |
Women with polycystic ovary syndrome (PCOS), defined as chronic oligoovulation or anovulation and hyperandrogenism, are primarily treated with clomiphene citrate as first line therapy if they desire pregnancy. However, women with PCOS have lower than expected pregnancy rates in response to clomiphene citrate. Approximately 20% of women with PCOS are resistant to clomiphene citrate. Subjects with chronic oligoovulation or anovulation and hyperandrogenism will ovulate 80% of the time, but pregnancy occurs in only 40%. The ideal initial treatment regimen for women with PCOS who desire pregnancy has not been determined. Metformin (Glucophage; Bristol-Myers Squibb, Princeton, NJ) is an insulin sensitizer and lowers serum insulin and androgen levels. Numerous case studies, case series, retrospective studies, and non-placebo controlled prospective studies, have suggested an improvement in insulin sensitivity, spontaneous menses, ovulatory response and pregnancies when metformin was given alone or prior to initiation of ovulation inducing agents in women with chronic anovulation and hyperandrogenism. However, there has been conflicting evidence in the literature regarding the effect of metformin alone or in combination with ovulation inducing agents regarding ovulation and pregnancy rates in prospective, randomized trials. Therefore, it remains unknown if the use of metformin plus clomiphene citrate in non-selected, infertility patients with PCOS improves ovulation and pregnancy rates compared to the use of clomiphene citrate alone.
Women with a history of infertility and diagnosed with hyperandrogenic, oligoovulatory or anovulatory cycles as the sole etiology for their infertility were randomized to receive clomiphene citrate 50 mg days 5-9, plus metformin 500 mg three times daily versus clomiphene plus placebo. The dose of clomiphene was increased up to a maximum dose of 250 mg in a step-wise fashion until ovulation was confirmed with an ovulation predictor kit. Once ovulation was confirmed the subjects continued the ovulatory dose of clomiphene for 6 ovulatory cycles or until conception. Metformin or placebo was started on cycle day one and discontinued 8 days after the LH surge and/or by cycle day 21. A positive HCG, ovulation rates and pregnancy outcome were the outcome measures.
Ages Eligible for Study: | 18 Years to 40 Years |
Genders Eligible for Study: | Female |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
Exclusion Criteria:
United States, Texas | |
Wiford Hall Medical Center | |
Lackland AFB, Texas, United States, 78236 |
Principal Investigator: | Randal D Robinson, MD | Wilford Hall Medical Center and Brooke Army Medical Center |
Study ID Numbers: | FWH19970383H |
Study First Received: | December 18, 2006 |
Last Updated: | December 18, 2006 |
ClinicalTrials.gov Identifier: | NCT00413179 History of Changes |
Health Authority: | United States: Institutional Review Board |
Polycystic Ovarian Syndrome Chronic Anovulation Chronic Oligoovulation Infertility |
Hyperandrogenism Metformin Ovulation induction |
Infertility Gonadal Disorders Hormone Antagonists Hormones, Hormone Substitutes, and Hormone Antagonists Clomiphene Hyperandrogenism Ovarian Diseases Selective Estrogen Receptor Modulators Sex Differentiation Disorders Hormones Polycystic Ovarian Syndrome Genital Diseases, Female Estrogen Receptor Modulators |
Hypoglycemic Agents Estrogens Estrogen Antagonists Metformin Citric Acid Endocrine System Diseases Cysts Genital Diseases, Male Polycystic Ovary Syndrome Endocrinopathy Anovulation Ovarian Cysts |
Infertility Gonadal Disorders Hormone Antagonists Physiological Effects of Drugs Hormones, Hormone Substitutes, and Hormone Antagonists Clomiphene Hyperandrogenism Reproductive Control Agents Ovarian Diseases Selective Estrogen Receptor Modulators Sex Differentiation Disorders Genital Diseases, Female Estrogen Receptor Modulators Hypoglycemic Agents Pathologic Processes |
Therapeutic Uses Syndrome Estrogen Antagonists Disease Metformin Endocrine System Diseases Cysts Genital Diseases, Male Pharmacologic Actions Adnexal Diseases Neoplasms Fertility Agents, Female Fertility Agents Polycystic Ovary Syndrome Anovulation |