Objective: To describe the first reported cases of two women with polycystic ovary syndrome (PCOS) desirous of pregnancy who conceived trichorionic pregnancies following ovulation induction with metformin alone and metformin plus clomiphene. Design: Case report. Setting: Private fertility practice. Patient(s): Two women with polycystic ovary syndrome, one lean and one overweight, both oligoovulatory and not undertaking their first cycle of treatment. Intervention(s): Ovulation induction by metformin alone or in combination with clomiphene. Main Outcome Measure(s): Higher-order multiple pregnancy (triplet or greater). Result(s): Two cases of trichorionic pregnancy. Conclusion(s): This is the first report of higher-order multiple pregnancies resulting from the use of either metformin alone or in combination with clomiphene. The additive effects of adjunctive treatments such as weight reduction, ovarian drilling, and clomiphene and metformin therapy may result in an increased incidence of higher-order multiple pregnancy and women need to be counseled about this risk. Further research is required to quantify the risk of this event per treatment cycle.
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