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Doctors have found that several patients with PCOD have insulin resistance - a situation much like which found in diabetics, in that they have increased levels of insulin in their blood (hyperinsulinemia), and their own reaction to insulin is blunted. That is why many patients with PCOD who just do not respond to clomiphene tend to be treated with antidiabetic medicines, such as metformin (Glyciphage, Glucophage). Research has proven that these types of drugs that are insulin sensitisers (they enhance the reaction of the body's cells to insulin) will help to increase their fertility by treating the endocrine abnormality in PCOD patients and therefore improving their ovulatory response.

For several infertile patients with PCOD, metformin could be the first choice of treatment. Some physicians will check for insulin resistance (by testing serum insulin levels after a glucose load) before starting metformin, and choose just those patients that have confirmed insulin resistance.