We read with interest the recent report by Vaughan and Bell (1), in which the addition of rosiglitazone to metformin to control glycemia in their 46-year-old patient of Euroasian decent resulted in an unplanned and unexpected, yet successful, pregnancy. This case is another anecdote for the potential usefulness of the glitazone class of drugs in treating the infertility of women with polycystic ovary syndrome (PCOS).

We recently encountered a similar situation in a woman in her 40s with a longstanding history of primary infertility due to PCOS. Her PCOS has been extensively, but ineffectively, managed since her early 20s, to the extent that she gave up hope of having children when she reached her mid-30s. She developed type 2 diabetes when she was 37 years of age, and after the addition of rosiglitazone to metformin to improve glycemia, she had an unexpected, successful pregnancy, giving birth to viable healthy twin males.

This case adds to the recent accumulating scientific usefulness of the combination of metformin and the glitazone class of drugs for improving the metabolic milieu and correcting the metabolic defects in women with PCOS (24). Vaughan and Bell’s case and ours suggest that the combined use of metformin and a glitazone agent may prove to be an attractive combination to tackle the infertility of women with PCOS; however, this will need to be tested by randomized controlled trials.

Though Vaughan and Bell have rightly pointed out the need to exercise caution in the use of this combination therapy and to fully counsel such women for the possibility of unexpected conception, we feel that only a randomized controlled trial will prove such safety.

Finally, such a combination may also provide some help to tackle other metabolic abnormalities of PCOS, like hirsutism and glucose intolerance (5,6).

1.
Vaughan TB, Bell DSH: Stockpiling of ovarian follicles and the response to rosiglitazone (Letter).
Diabetes Care
28
:
2333
–2334,
2005
2.
Seto-Young D, Paliou M, Schlosser J, Avtanski D, Park A, Patel P, Holcomb K, Chang P, Poretsky L: Direct thiazolidinedione action in the human ovary: insulin independent and insulin sensitizing effects on steroidogenesis and insulin-like growth factor protein-1 production.
J Clin Endocrinol Metab
90
:
6099
–6105,
2005
3.
Sepilian V, Nagamani M: Effects of rosiglitazone in obese women with polycystic ovary syndrome and severe insulin resistance.
J Clin Endocrinol Metab
90
:
60
–65,
2004
4.
Glueck CJ, Moriera A, Goldenberg N, Sieve L, Wang P: Pioglitazone and metformin in obese women with polycystic ovary syndrome not optimally responsive to metformin.
Hum Reprod
18
:
1618
–1625,
2003
5.
Yilmaz M, Karakoc A, Toruner FB, Cakir N, Tiras B, Ayvas G, Arslan M: The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome.
Gynecol Endocrinol
21
:
154
–160,
2005
6.
Dereli D, Dereli T, Bayraktar F, Ozgen AG, Yilmaz C: Endocrine and metabolic effects of rosiglitazone in non-obese women with polycystic ovary syndrome.
Endocr J
52
:
299
–308,
2005