Position of alternatives: insulin sensitizers and others

The association between the polycystic ovary syndrome (PCOS) and insulin resistance has led to the use of insulin-sensitizing drugs to induce ovulations. Metformin was shown to lower insulin levels effectively, and metformin alone, as well as in combination with clomiphene citrate (CC), has been shown to enhance ovulation in PCOS patients. However, insulin-sensitizing medications have considerable side-effects, and lifestyle improvements (weight reduction and increased exercise) should be considered as first-line treatments in overweight women with PCOS. At present, metformin may best be used as an adjuvant therapy in CC-refractory PCOS patients.