Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

Tang, Thomas; Lord, Jonathan M; Norman, Robert J; Yasmin, Ephia; Balen, Adam H

doi:10.1002/14651858.cd003053.pub5

Cited by 698Ovarian function and disordersDiabetes, Cardiovascular Risks, and LipoproteinsEndometriosis Research and Treatment

Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

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Tang, Thomas, Lord, Jonathan M, Norman, Robert J, Yasmin, Ephia, Balen, Adam H·2012·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd003053.pub5PMC PMC6486196

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Abstract

BACKGROUND: Polycystic ovary syndrome (PCOS) is characterised by infrequent or absent ovulation, and high levels of androgens and insulin (hyperinsulinaemia). Hyperinsulinaemia occurs secondary to insulin resistance and is associated with increased risk of cardiovascular disease and diabetes mellitus. Insulin-sensitising agents such as metformin may be effective in treating PCOS-related anovulation. OBJECTIVES: To evaluate the effectiveness and safety of insulin-sensitising drugs in improving reproductive and metabolic outcomes for women with PCOS undergoing ovulation induction. SEARCH METHODS: We searched the following databases from inception to January 2017: Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL. We searched registers of ongoing trials and reference lists from relevant studies. SELECTION CRITERIA: We included randomised controlled trials of insulin-sensitising drugs compared with placebo, no treatment, or an ovulation-induction agent for women with oligo and anovulatory PCOS. DATA COLLECTION AND ANALYSIS: statistic and reported quality of the evidence for primary outcomes using GRADE methodology. MAIN RESULTS: = 52%, very low-quality evidence). D-chiro-inositol (2 studies), rosiglitazone (1 study) or pioglitazone (1 study) versus placebo or no treatmentWe were unable to draw conclusions regarding other insulin-sensitising drugs as no studies reported primary outcomes. AUTHORS' CONCLUSIONS: Our updated review suggests that metformin alone may be beneficial over placebo for live birth, although the evidence quality was low. When metformin was compared with clomiphene citrate, data for live birth were inconclusive, and our findings were limited by lack of evidence. Results differed by body mass index (BMI), emphasising the importance of stratifying results by BMI. An improvement in clinical pregnancy and ovulation suggests that clomiphene citrate remains preferable to metformin for ovulation induction in obese women with PCOS.An improved clinical pregnancy and ovulation rate with metformin and clomiphene citrate versus clomiphene citrate alone suggests that combined therapy may be useful although we do not know whether this translates into increased live births. Women taking metformin alone or with combined therapy should be advised that there is no evidence of increased miscarriages, but gastrointestinal side effects are more likely.

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Two prior systematic reviews of metformin alone versus placebo or no intervention in PCOS found no effect on BMI.
“Two other systematic reviews on metformin alone compared with placebo or no intervention in PCOS, showed no effect on BMI (Lord et al. , 2003; Tang et al. , 2012).”
From Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis (2015) · cites this paper as Tang et al. , 2012
Metformin is prescribed to target insulin resistance and pre-diabetes risk, androgen production, cardiometabolic risk factors and reproductive concerns.
“Metformin was prescribed in 8% and 44% of respondents at diagnosis and at follow-up clinic visits, respectively, to target insulin resistance and pre-diabetes risk, androgen production, cardiometabolic risk factors and reproductive concerns [67–70].”
From Challenges in diagnosis and health care in polycystic ovary syndrome in Canada: a patient view to improve health care (2023) · cites this paper as [67]
A Cochrane meta-analysis showed a reduction in fasting glucose with metformin compared to placebo or no treatment, with mean difference −0.14 mmol/L (95% CI −0.21 to −0.07).
“However, a Cochrane meta-analysis [47] evaluating as secondary outcome fasting glucose levels has shown a reduction in fasting glucose with metformin compared to placebo or no treatments, with mean difference (MD −0.14 mmol/L; 95% CI −0.21 to −0.07).”
From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [47]
Metabolic outcomes were assessed by all the reviews with important results: reduced insulin levels, reduced glucose levels and HOMA-IR, and improved blood pressure, triglycerides, and high-density lipoprotein.
“Metabolic outcomes were assessed by all the reviews with important results: reduced insulin levels [47, 72, 85], reduced glucose levels and HOMA-IR, and improved blood pressure, triglycerides, and high-density lipoprotein [86].”
From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [47]
Three reviews including 62 trials with 5072 women with PCOS evaluated the efficacy of inositol in PCOS; endocrine outcomes were assessed by all the reviews with benefits reported in testosterone, DHEA, or androstenedione levels.
“Three reviews including a total of 62 trials with 5072 women with PCOS evaluated the efficacy of inositol in PCOS [47, 85, 86]. Endocrine outcomes were assessed by all the reviews with benefits reported in testosterone, dehydroepiandrosterone (DHEA), or androstenedione levels.”
From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [47]

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Early Effects of Metformin in Women with Polycystic Ovary Syndrome: A Prospective Randomized, Double-Blind, Placebo-Controlled Trial
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Total and high molecular weight (HMW) adiponectin levels and measures of glucose and lipid metabolism following pioglitazone treatment in a randomized placebo‐controlled study in polycystic ovary syndrome
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Effect of pioglitazone on glucose metabolism and luteinizing hormone secretion in women with polycystic ovary syndrome
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The effects of metformin on insulin resistance, clomiphene-induced ovulation and pregnancy rates in women with polycystic ovary syndrome
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Ultra‐short metformin pretreatment for clomiphene citrate‐resistant polycystic ovary syndrome
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Minimal Response of Circulating Lipids in Women with Polycystic Ovary Syndrome to Improvement in Insulin Sensitivity with Troglitazone
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Metformin versus lifestyle changes in treating women with polycystic ovary syndrome
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Prevalence of the metabolic syndrome in Asian women with polycystic ovary syndrome: Using the International Diabetes Federation criteria
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The metabolic syndrome in young Korean women with polycystic ovary syndrome
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Metformin effects on ovarian ultrasound appearance and steroidogenic function in normal-weight normoinsulinemic women with polycystic ovary syndrome: A randomized double-blind placebo-controlled clinical trial
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Polycystic ovary syndrome and fat distribution: The central issue?
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Correction of Insulin Resistance and Hyperandrogenism in Polycystic Ovary Syndrome By Combined Rosiglitazone and Clomiphene Citrate Therapy
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The Decrease in Luteinizing Hormone Secretion in Response to Weight Reduction Is Inversely Related to the Severity of Insulin Resistance in Overweight Women
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Does adding metformin to clomifene citrate lead to higher pregnancy rates in a subset of women with polycystic ovary syndrome?
Moll, E., Korevaar, J. C., Bossuyt, P. M., & van der Veen, F. (2008) · Human Reproduction · doi:10.1093/humrep/den182 · Cited by 49 · see citing works
Polycystic ovary syndrome: Current and future treatment paradigms
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Mitochondrial Inhibitor as a New Class of Insulin Sensitizer
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Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome.
Jensterle, M., Janez, A., Mlinar, B., Marc, J., Prezelj, J., & Pfeifer, M. (2008) · European Journal of Endocrinology · doi:10.1530/eje-07-0857 · Cited by 47 · see citing works
The effect of metformin plus clomiphene citrate on ovulation and pregnancy rates in clomiphene-resistant women with polycystic ovary syndrome
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Is Metformin Indicated as Primary Ovulation Induction Agent in Women with PCOS? A Systematic Review and Meta-Analysis
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Effects of metformin and clomiphene citrate on ovarian vascularity in patients with polycystic ovary syndrome
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Does metformin affect the ovarian response to gonadotropins for in vitro fertilization treatment in patients with polycystic ovary syndrome and reduced ovarian reserve? A randomized controlled trial
Palomba, S., Falbo, A. I., Cello, A. D., Cappiello, F., Tolino, A., & Zullo, F. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.08.020 · Cited by 45 · see citing works
Retinol-Binding Protein 4 in Polycystic Ovary Syndrome—Association with Steroid Hormones and Response to Pioglitazone Treatment
Aigner, E. S., Bachofner, N., Klein, K., Geyter, C. D., Hohla, F., Patsch, W., & Datz, C. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2156 · Cited by 44 · see citing works
Pioglitazone Treatment Increases Spontaneous Growth Hormone (GH) Secretion and Stimulated GH Levels in Polycystic Ovary Syndrome
Glintborg, D., Støving, R. K., Hagen, C., Hermann, A. P., Frystyk, J., Veldhuis, J. D., Flyvbjerg, A., & Andersen, M. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0615 · Cited by 43 · see citing works
Is insulin resistance an essential component of PCOS?: The influence of confounding factors
Cibula, D. (2004) · Human Reproduction · doi:10.1093/humrep/deh137 · Cited by 43 · see citing works
Type 2 diabetes and polycystic ovary syndrome
Legro, R. S. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.04.010 · Cited by 40 · see citing works
What role of estrogens in ovarian stimulation
Laven, J. S. E., & Fauser, B. C. J. M. (2006) · Maturitas · doi:10.1016/j.maturitas.2006.04.022 · Cited by 34 · see citing works
Rosiglitazone treatment alleviates inflammation and improves liver function in overweight women with polycystic ovary syndrome: a randomized placebo-controlled study
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Does metformin induce ovulation in normoandrogenic anovulatory women?
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A randomized placebo-controlled study on the effects of pioglitazone on cortisol metabolism in polycystic ovary syndrome
Glintborg, D., Hermann, A. P., Hagen, C., Jensen, L. T., Frystyk, J., Bennett, P., Flyvbjerg, A., & Andersen, M. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2007.12.082 · Cited by 25 · see citing works
The effect of administration of metformin on lipid profile changes andinsulin resistance in patients with polycystic ovary syndrome
Karimzadeh, M. A., Eftekhar, M., Taheripanah, R., Tayebi, N., Sakhavat, L., & Zare, F. (2007) · TSpace (University of Toronto) · Cited by 25 · see citing works
Evaluating the equivalence of clomiphene citrate with and without metformin in ovulation induction in PCOS patients
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Leanza, V., Coco, L., Grasso, F., Leanza, G., Zarbo, G., & Palumbo, M. A. (2014) · PubMed · Cited by 22 · see citing works
Possible metformin effect on adrenal androgens during pretreatment and IVF cycle in women with polycystic ovary syndrome
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Efficacy of combined metformin-clomiphene citrate in comparison with clomiphene citrate alone in infertile women with polycystic ovarian syndrome (PCOS).
Ayaz, A., Alwan, Y., & Farooq, M. U. (2013) · PubMed · Cited by 20 · see citing works
Metformin effects on clomifene-induced ovulation in the polycystic ovary syndrome.
Ayed, B. B., Mlik, S. D. D., Arab, H. B., Trabelsi, H., Chahtour, H., Mathlouthi, N., Dhuib, M., Kassis, M., Saiidane, D., Trabelsi, K., et al. (2009) · PubMed · Cited by 20 · see citing works
Analysis of factors predicting success of metformin and clomiphene treatment for women with infertility owing to PCOS-related ovulation dysfunction in a randomised controlled trial
JOHNSON, N. P., Bontekoe, S., & Stewart, A. W. (2011) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/j.1479-828x.2011.01295.x · Cited by 18 · see citing works
[Study on treatment of hyperandrogenism and hyperinsulinism in polycystic ovary syndrome with Chinese herbal formula "tiangui fang"].
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Extended-Release Metformin Does Not Reduce the Clomiphene Citrate Dose Required to Induce Ovulation in Polycystic Ovary Syndrome
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Metformin-clomiphene citrate vs. clomiphene citrate alone: Polycystic ovarian syndrome
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Health-related quality of life in women with newly diagnosed polycystic ovary syndrome randomized between clomifene citrate plus metformin or clomifene citrate plus placebo
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Efficacy of Metformin in Obese and Non-obese Women With Polycystic Ovary Syndrome: A Randomized, Double-Blinded, Placebo-Controlled Cross-Over Trial
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Clomiphene citrate alone, in combination with metformin or in combination with pioglitazone as first line therapy in induction of ovulation in infertile women with polycystic ovary syndrome, a randomized controlled trial
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Metformin-therapy Effects in 50 Clomiphene Citrate Resistant PCOS Patients
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Abnormal liver function tests
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Does metformin augment the ovulation inducing effects of clomiphene in non-obese women with polycystic ovary syndrome?
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Insulin-sensitising drugs for polycystic ovary syndrome
Tang, T. H., Lord, J. M., Norman, R. J., Yasmin, E., & Balen, A. H. (2009) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003053.pub2 · Cited by 9 · see citing works
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Characteristics of polycystic ovary syndrome with and without insulin resistance and the role of insulinsensitizing drug (metformin) in its management
Refaie, A., Ibrahim, G., & Oash, S. A. (2005) · TSpace (University of Toronto) · Cited by 9 · see citing works
[Indication of metformin in the management of hormonal dysfunction secondary to polycystic ovarian syndrome: prospective comparative study of 63 cases].
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Co-administration of metformin during recombinant follicle stimulating hormone (recombinant FSH) treatment using the low-dose step-up protocol in patients with clomiphene citrate resistant polycystic ovary syndrome (PCOS): a prospective randomized trial.
Yaralı́, H., Yýldýz, B. O., Demi̇rol, A., Zeyneloğlu, H. B., Yigit, N., & Bükülmez, O. (2001) · Fertility and Sterility · doi:10.1016/s0015-0282(01)02126-4 · Cited by 6 · see citing works
A randomized, placebo-controlled study of the influence of instant-release metformin on response to clomiphene citrate and time to conception in polycystic ovary syndrome
Williams, C. D., Pastore, L. M., Shelly, W. B., Bailey, A. P., Baras, D. C., & Bateman, B. G. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.07.1076 · Cited by 6 · see citing works

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Polycystic Ovary Syndrome: Definition, Aetiology, Diagnosis and Treatment
Escobar-Morreale, H. F. (2018) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2018.24 · Cited by 2,083 · see citing works
Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group
Fauser, B. C. J. M., Tarlatzis, B. C., Rebar, R. W., Legro, R. S., Balen, A. H., Lobo, R., Carmina, E., Chang, J., Yildiz, B. O., Laven, J. S. E., et al. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.09.024 · Cited by 1,976 · see citing works
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Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications
Diamanti-Kandarakis, E., & Dunaif, A. (2012) · Endocrine Reviews · doi:10.1210/er.2011-1034 · Cited by 1,947 · see citing works
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American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines For Medical Care of Patients with Obesity
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Gestational diabetes mellitus
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Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome
Dumesic, D. A., Oberfield, S. E., Stener-Victorin, E., Marshall, J. C., Laven, J. S., & Legro, R. S. (2015) · Endocrine Reviews · doi:10.1210/er.2015-1018 · Cited by 1,020 · see citing works
The management of anovulatory infertility in women with polycystic ovary syndrome: An analysis of the evidence to support the development of global who guidance
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Understanding the glucoregulatory mechanisms of metformin in type 2 diabetes mellitus
Foretz, M., Guigas, B., & Viollet, B. (2019) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0242-2 · Cited by 686 · see citing works
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Causal mechanisms and balancing selection inferred from genetic associations with polycystic ovary syndrome
Day, F. R., Hinds, D. A., Tung, J. Y., Stolk, L., Styrkarsdottir, U., Saxena, R., Bjonnes, A., Broer, L., Dunger, D. B., Halldorsson, B. V., et al. (2015) · Nature Communications · doi:10.1038/ncomms9464 · Cited by 459 · see citing works
Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics
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Assessment and management of polycystic ovary syndrome: Summary of an evidence-based guideline
Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G. A., Wong, J. L. A., Norman, R. J., Costello, M. F., & Groups, O. B. O. T. G. D. (2011) · Medical Journal of Australia · doi:10.5694/mja11.10915 · Cited by 379 · see citing works
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Metformin and lifestyle modification in polycystic ovary syndrome: systematic review and meta-analysis
Naderpoor, N., Shorakae, S., de Courten, B., Misso, M. L., Moran, L. J., & Teede, H. J. (2015) · Human Reproduction Update · doi:10.1093/humupd/dmv025 · Cited by 334 · see citing works
Metformin versus placebo from first trimester to delivery in polycystic ovary syndrome: a randomized, controlled multicenter study
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Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility
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Complications and challenges associated with polycystic ovary syndrome: current perspectives
Palomba, S., Santagni, S., Falbo, A., & La Sala, G. B. (2015) · International Journal of Women's Health · doi:10.2147/ijwh.s70314 · Cited by 287 · see citing works
Exercise therapy in polycystic ovary syndrome: a systematic review
Harrison, C. L., Lombard, C. B., Moran, L. J., & Teede, H. J. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmq045 · Cited by 267 · see citing works
Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): a multicenter, double-blind, placebo-controlled randomized trial
Morin-Papunen, L., Rantala, A. S., Unkila-Kallio, L., Tiitinen, A., Hippeläinen, M., Perheentupa, A., Tinkanen, H., Bloigu, R., Puukka, K., Ruokonen, A., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3061 · Cited by 243 · see citing works
Insulin resistance and PCOS: chicken or egg?
Moghetti, P., & Tosi, F. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01351-0 · Cited by 209 · see citing works
A Summary on Polycystic Ovary Syndrome: Diagnostic Criteria, Prevalence, Clinical Manifestations, and Management According to the Latest International Guidelines
Neven, A., Laven, J., Teede, H., & Boyle, J. (2018) · Seminars in Reproductive Medicine · doi:10.1055/s-0038-1668085 · Cited by 196 · see citing works
The management of patients with polycystic ovary syndrome
Jayasena, C. N., & Franks, S. (2014) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2014.102 · Cited by 196 · see citing works
Current Knowledge of Obesity’s Effects in the Pre-and Periconceptional Periods and Avenues for Future Research
Jungheim, E. S., & Moley, K. H. (2010) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.06.043 · Cited by 190 · see citing works
Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings
Arentz, S., Abbott, J. A., Smith, C. A., & Bensoussan, A. (2014) · BMC Complementary and Alternative Medicine · doi:10.1186/1472-6882-14-511 · Cited by 191 · see citing works
Polycystic ovary syndrome throughout a woman’s life
Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF), Bellver, J., Rodríguez-Tabernero, L., Robles, A., Muñoz, E., Martínez, F., Landeras, J., García-Velasco, J., Fontes, J., Álvarez, M., et al. (2018) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-017-1047-7 · Cited by 180 · see citing works
First-trimester exposure to metformin and risk of birth defects: a systematic review and meta-analysis
Cassina, M., Donà, M., Di Gianantonio, E., Litta, P., & Clementi, M. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmu022 · Cited by 143 · see citing works
Recent advances in the understanding and management of polycystic ovary syndrome
Rocha, A. L., Oliveira, F. R., Azevedo, R. C., Silva, V. A., Peres, T. M., Candido, A. L., Gomes, K. B., & Reis, F. M. (2019) · F1000Research · doi:10.12688/f1000research.15318.1 · Cited by 142 · see citing works
Metformin and Other Pharmaceuticals Widespread in Wadeable Streams of the Southeastern United States
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Authors: Tang, T., Lord, J. M., Norman, R. J., Yasmin, E., & Balen, A. H.
Affiliations: Bradford Teaching Hospitals NHS Foundation Trust (GB)
Royal Cornwall Hospital (GB)
The University of Adelaide (AU)
Leeds General Infirmary (GB)
ORCID: Lord, Jonathan M
Norman, Robert J
Yasmin, Ephia
Balen, Adam H
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2012-05-16
Volume: 11
Issue: 5
Pages: CD003053-CD003053
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd003053.pub5
PMC: PMC6486196
OpenAlex: W2149842750
Cited by: 698
References: 201
Citations by year: 2026: 3 · 2025: 15 · 2024: 21 · 2023: 37 · 2022: 35 · 2021: 54 · 2020: 45 · 2019: 54 · 2018: 44 · 2017: 54 · 2016: 46 · 2015: 67 · 2014: 60 · 2013: 50 · 2012: 43
FWCI: 9.58
Type: journal article
Language: en
Update notices: new_version (2017-11-28)
Open access: green
www.ncbi.nlm.nih.gov
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Topics: Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
Keywords: metformin, rosiglitazone, pioglitazone, D-chiro-inositol, polycystic ovary syndrome, subfertility, anovulation, ovulation induction, clomiphene citrate, live birth rate, clinical pregnancy rate, insulin resistance, hyperinsulinemia
MeSH terms: Anovulation, Clomiphene, Female, Humans, Hypoglycemic Agents, Infertility, Female, Inositol, Insulin Resistance, Metformin, Ovulation Induction, Polycystic Ovary Syndrome, Pregnancy, Randomized Controlled Trials as Topic, Pregnancy Rate, Thiazolidinediones, Live Birth

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Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility

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