Insulin sensitizing agent (metformin) improves clinical pregnancy rate in clomiphene citrate resistant polycystic ovarian syndrome patients with acanthosis nigricans

Abstract

ObjectiveThere are several studies that showed a positive correlation between acanthosis nigricans (AN) with hyperinsulinemia and increased insulin resistance. The present study evaluated the effect of adding insulin sensitizing agent (metformin) to clomiphene citrate (CC) on improving insulin resistance parameters and pregnancy rate (PR) in clomiphene-resistant polycystic ovary (PCOS) patients with AN.DesignA double blinded randomized control trialed.Materials and MethodsSixty six CC resistant PCO patients (unsatisfactory ovulation after at least 3 month of CC induction) with AN had been recruited in the study. All study participants had proper clinical evaluation to ensure the diagnosis of AN. Additionally, day 3 follicle stimulating hormone level, fasting insulin, fasting glucose and homeostatic model assessment used to quantify insulin resistance (HOMA–IR) were done. Randomization was done using serial number closed opaque envelopes. Blinding was done using two identical packages for induction (group I) two 50 mg CC tablets taken from day 3 to day 7 of the cycle + placebo tablets taken twice daily all through the cycle (Group II) received the above CC dose + metformin 500 mg twice daily continuously for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi-square and Fischer exact tests.ResultsTable 1GI(CC)GII (CC + metformin)P. valueMeanSDMeanSDFasting glucose96.856.8489.766.220.001Fasting insulin12.063.127.832.950.005HOMA_IR2.900.711.720.670.001 Open table in a new tab ConclusionAddition of metformin to CC in PCOS patients with AN, decreases insulin resistance and improve clinical pregnancy rate in patients with previous unsatisfactory response to CC alone. ObjectiveThere are several studies that showed a positive correlation between acanthosis nigricans (AN) with hyperinsulinemia and increased insulin resistance. The present study evaluated the effect of adding insulin sensitizing agent (metformin) to clomiphene citrate (CC) on improving insulin resistance parameters and pregnancy rate (PR) in clomiphene-resistant polycystic ovary (PCOS) patients with AN. There are several studies that showed a positive correlation between acanthosis nigricans (AN) with hyperinsulinemia and increased insulin resistance. The present study evaluated the effect of adding insulin sensitizing agent (metformin) to clomiphene citrate (CC) on improving insulin resistance parameters and pregnancy rate (PR) in clomiphene-resistant polycystic ovary (PCOS) patients with AN. DesignA double blinded randomized control trialed. A double blinded randomized control trialed. Materials and MethodsSixty six CC resistant PCO patients (unsatisfactory ovulation after at least 3 month of CC induction) with AN had been recruited in the study. All study participants had proper clinical evaluation to ensure the diagnosis of AN. Additionally, day 3 follicle stimulating hormone level, fasting insulin, fasting glucose and homeostatic model assessment used to quantify insulin resistance (HOMA–IR) were done. Randomization was done using serial number closed opaque envelopes. Blinding was done using two identical packages for induction (group I) two 50 mg CC tablets taken from day 3 to day 7 of the cycle + placebo tablets taken twice daily all through the cycle (Group II) received the above CC dose + metformin 500 mg twice daily continuously for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi-square and Fischer exact tests. Sixty six CC resistant PCO patients (unsatisfactory ovulation after at least 3 month of CC induction) with AN had been recruited in the study. All study participants had proper clinical evaluation to ensure the diagnosis of AN. Additionally, day 3 follicle stimulating hormone level, fasting insulin, fasting glucose and homeostatic model assessment used to quantify insulin resistance (HOMA–IR) were done. Randomization was done using serial number closed opaque envelopes. Blinding was done using two identical packages for induction (group I) two 50 mg CC tablets taken from day 3 to day 7 of the cycle + placebo tablets taken twice daily all through the cycle (Group II) received the above CC dose + metformin 500 mg twice daily continuously for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi-square and Fischer exact tests. ResultsTable 1GI(CC)GII (CC + metformin)P. valueMeanSDMeanSDFasting glucose96.856.8489.766.220.001Fasting insulin12.063.127.832.950.005HOMA_IR2.900.711.720.670.001 Open table in a new tab ConclusionAddition of metformin to CC in PCOS patients with AN, decreases insulin resistance and improve clinical pregnancy rate in patients with previous unsatisfactory response to CC alone. Addition of metformin to CC in PCOS patients with AN, decreases insulin resistance and improve clinical pregnancy rate in patients with previous unsatisfactory response to CC alone.