Reproductive function in obesity and insulin resistance

Question 1

A 29-year-old nulliparous woman comes to your office because she wishes to conceive. She has a body mass index (BMI) (weight in kilograms divided by height in meters squared [kg/m2]) of 37. She has irregular menstrual cycles and a finding of acanthosis nigricans around her neck and axillae. Her fasting glucose level is 108 mg/dL. The best treatment to achieve pregnancy in this patient is:

(A) glyburide
(B) metformin hydrochloride (Glucophage)
(C) clomiphene citrate (Clomid, Serophene)
(D) lifestyle modifications
(E) gastric bypass surgery

Answer 1

(D) lifestyle modifications

Question 2

If an obese patient with PCOS is unable to conceive after lifestyle modifications, what treatments can be used to help?

Answer 2

Clomiphene citrate (Clomid, Serophene): 1st line, induces ovulation; more effective (22.5% live birth rates) than metformin alone (7.2%) and comparable to using both (26.8%)

Metformin: insulin sensitization