The study demonstrated that metformin was associated with a borderline significant reduction in the FAI ( P = .05) and with a reduction in the serum concentration of LH-stimulated testosterone (T) ( P = .03). 44 Long-term studies have shown improvement in menstrual abnormalities in about 50% after use of metformin. 45 A recent update of the Cochrane review of insulin-sensitising agents and PCOS included 4227 participants.
A statistically significant difference between aerobic training and control group ( P = .001) and a trend towards significance when strength training and control groups were compared ( P = .52). 24 Pharmacological Treatment The principle of pharmacological fertility treatment in women with PCOS is to treat anovulation as PCOS represents 80% of anovulatory World Health Organization (WHO) type II infertility. 25 Oral Agents Oral ovulation induction agents, such as clomiphene citrate (CC) and letrozole, and an insulin sensitiser, such as metformin, are the first-line pharmacological treatment for anovulatory infertility and no other infertility factors in women with PCOS.