Objective: The aim of this literature search is to establish if metformin is efficacious when given to clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients.Design: Medline database was searched from 1 January 1980 to 1 January 2005. Inclusion criteria were prospective randomized control trials where metformin was randomized either with placebo or CC to induce ovulation in the CC resistant patient.Result(s): Group 1: Four trials were propspective double-blind placebo controlled. When the data of the four trials were pooled, the overall effect of the addition of metformin in the CC patient was p = .0006 with a 95% confidence interval (CI) of odds ratio (OR) 1.81-8.84. Group 2: In two trials the randomization was only prospective. When the data of these two trials were pooled, the overall effect of the addition of metformin in the CC-resistant was P <.0001 with a 95% CI of 6.24-70.27. Groups 1 and 2: The combined data show an overall effect of P <.0001 with a 95% CI of OR 3.59-12.96.Conclusion(s): The addition of metformin in the CC-resistant patient is highly effective in achieving ovulation induction.

ObjectiveTo report an extremely rare case of endotoxic shock due to Enterobacter cloacae that occurred after laparoscopy for gamete intrafallopian transfer (GIFT) in a nulligravid woman.DesignPrivate fertility center in Cape Town, South Africa.SettingCase report.Patient(s)A 34-year-old woman with primary infertility.Intervention(s)Routine preparation for GIFT procedure, sonar aspiration to obtain oocytes, followed by GIFT. Endotoxic shock developed within hours after the procedure, followed by admission to the intensive care unit, intravenous antibiotic therapy, mechanical ventilation, and abdominal hysterectomy.Main outcome measure(s)Preventing patient mortality and morbidity.Result(s)Discharge from the intensive care unit occurred on day 11 after GIFT, which was day 8 after surgery. A MEDLINE search (1980 to 2003) found no previous literature on endotoxic shock associated with assisted reproduction.Conclusion(s)Gram-negative infection with subsequent endotoxic shock after assisted reproductive techniques is extremely rare. As this case report shows, early diagnosis and active management of these cases are mandatory to prevent serious complications and mortality.