Dr. M. Alagarraja

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting women of reproductive age, frequently complicated by anovulatory infertility and insulin resistance. Clomiphene citrate (CC) is the established first-line agent for ovulation induction, but a subset of women exhibits clomiphene resistance. Metformin, an insulin-sensitizing agent, has been proposed as an adjunct to improve ovulatory response in these patients. To compare the safety and efficacy of metformin combined with clomiphene citrate versus clomiphene citrate alone in the management of PCOS. This prospective comparative study was conducted in the Department of Obstetrics and Gynaecology, Coimbatore Medical College Hospital, from July 2025 to December 2025. Forty-two women diagnosed with PCOS were allocated to two groups (n=21 each): Group A received CC alone, and Group B received metformin plus CC. Outcomes assessed included ovulation rate, menstrual cycle regularity, conception rate, adverse effects, and metabolic parameters. Baseline demographic, hormonal, and metabolic parameters were comparable between groups (p>0.05). Ovulation, menstrual regularity, and conception rates were significantly higher in the metformin + CC group compared to CC alone (p<0.05 for all outcomes). Gastrointestinal adverse effects — loss of appetite (60%) and nausea/vomiting (18%) — occurred exclusively in the metformin + CC group but did not lead to treatment discontinuation. No cases of ovarian hyperstimulation syndrome, multiple pregnancy, or teratogenicity were observed in either group. Combination therapy with metformin and clomiphene citrate was more effective than clomiphene citrate alone in inducing ovulation, restoring menstrual regularity, and achieving conception in women with PCOS, with a manageable and non-limiting adverse effect profile. Metformin + CC may be considered a preferable first-line option, particularly in women with insulin resistance. Polycystic ovary syndrome, metformin, clomiphene citrate, ovulation induction, insulin resistance.