Fertility treatment in women with polycystic ovary syndrome: a decision analysis of different oral ovulation induction agents

Objective: To compare different oral ovulation induction agents in treating infertile women with polycystic ovary syndrome (PCOS). Design: Decision-analytic model comparing three treatment strategies using probability estimates derived from literature review and sensitivity analyses performed on the baseline assumptions. Setting: Outpatient reproductive medicine and gynecology practices. Patient(s): Infertile women with PCOS. Intervention(s): Metformin, clomiphene citrate, or metformin with clomiphene citrate. Main Outcome Measure(s): Live birth. Result(s): Within the baseline assumptions, combination therapy with metformin and clomiphene citrate was the preferred therapy for achieving live birth in women with PCOS. Sensitivity analysis revealed the model to be robust over a wide range of probabilities. Conclusion(s): Combination therapy with metformin and clomiphene citrate should be considered as first-line treatment for infertile women with PCOS. (Fertil Steril (R) 2010;94:2659-64. (C) 2010 by American Society for Reproductive Medicine.)