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Abstract

Background: Ovulation induction represents one of the most important treatments for infertility and most commonly utilizes clomiphene citrate. Nevertheless, evidence from recent studies indicates that the addition of metformin may enhance treatment success in women of normal BMI. Objective: To compare the efficacy of clomiphene citrate-metformin combination and clomiphene citrate monotherapy for ovulation induction in infertile patients with normal BMI. Study Design: Randomized controlled trial. Duration and Place of Study: The study was conducted from December 2024 to May 2025 at the Department of Obstetrics and Gynaecology, POF Hospital Wah Cantt. Methodology: A total of 100 infertile women aged 25-35 years with a normal BMI (20–25 kg/m²) were enrolled using non-probability consecutive sampling. Patients were randomized into two groups: Group A (clomiphene citrate 50 mg combined with metformin 1500 mg daily) and Group B (clomiphene citrate 50 mg daily). The primary endpoint was ovulation, assessed by progesterone levels on the 21st day of the menstrual cycle. Results: The combination therapy group (Group A) demonstrated a significantly higher ovulation rate (74%) compared to the monotherapy group (Group B), which showed a 30% success rate (p<0.01). Stratified analysis revealed superior outcomes in younger patients (≤30 years), those with a BMI ≤23 kg/m², and those with a shorter duration of infertility (≤5 years). Conclusion: Clomiphene citrate-metformin combination therapy is significantly more effective than clomiphene citrate monotherapy for ovulation induction in infertile women, particularly in younger women and those with a normal BMI.