A 28-year-old woman with PCOS and BMI 32 kg/m² is initiating clomiphene citrate for ovulation induction. She has been on metformin for 6 months. Which intervention, when added to clomiphene, has demonstrated improved live birth rates in a Cochrane review?
- A Continuing metformin plus clomiphene versus clomiphene alone ✓
- B Letrozole added to clomiphene
- C Weight loss of ≥5% body weight before starting clomiphene
- D N-acetylcysteine combined with clomiphene
Correct answer: A. Continuing metformin plus clomiphene versus clomiphene alone
Explanation
Multiple Cochrane reviews and the PPCOS trial have examined metformin plus clomiphene versus clomiphene alone in PCOS. Metformin combined with clomiphene significantly improved ovulation and clinical pregnancy rates in women with PCOS. A 2017 Cochrane review confirmed improved live birth rates with metformin + clomiphene compared to clomiphene alone. While letrozole alone is superior to clomiphene alone (LEGRO 2014, NEJM), the combination of letrozole + clomiphene is not standard practice.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.