BACKGROUND: Polycystic ovarian syndrome (PCOS) is the most common hormonal 
dysfunction in women. It's a cause of female infertility by oligoanovulation, 
clinical and biochemical hyperandrogenism and polycystic ovaries. Weight loss, 
firstly proposed in overweight or obese patient suffering from PCOS, aims to 
reduce hyperinsulinism and hyperandrogenism. Recently, Metformin, an insulin 
sensitizer, has been proposed as an alternative first line treatment for 
polycystic ovarian syndrome by improving hyperinsulinemia and hyperandrogenism 
in these women.
AIM: The aim of our study, and through a literature review, is to demonstrate if 
Metformin should be used as a first-line drug for infertile women with this 
syndrome or as an adjunction to Clomifene Citrate, the longest established 
treatment already used in this syndrome.
METHODS: A prospective comparative study including 63 patients with PCOS has 
been done during 2 years. Women were randomly allocated to clomifene + Metformin 
(Metformin group, Metformin took during 8 weeks, 850 mg twice a day, plus 
Clomifene 100 mg per day during five days) or Clomifene only (100 mg per day 
during five days). All patients underwent a two- month's diet.
RESULTS: The middle age was about 30.63 years and the body mass index (BMI) was 
about 29.88 kg/ m(2). We noticed a 6.2% weight loss in both groups (a non 
significant difference in p=0.04). The median of infertility period was about 
2.49 years. The ovulation rate in the Metformin group was 53.12% (significant 
difference for inducing ovulation p=0.02) and 32.25% in Clomifene group 
(non-significant difference 0.07). There was also a significant difference for 
ongoing pregnancies (p=0.04). In fact, 11 on 32 patients (34%) achieved a 
full-term pregnancy in Metformin group versus only 4 ones on 31 patients (12.9%) 
in Clomifene group.
CONCLUSION: Our conclusion is that Metformin is an effective addition to 
Clomifene Citrate in term of reestablishment of ovulation and full-term 
pregnancies achievement, excluding ART cycles.