Metformin, basically a biguanide, is an anti-hyperglycemic agent that improves glucose tolerance, increases the action of insulin at cellular levels without affecting insulin secretion (2). Metformin has been used in the management of insulin resistance, hyperinsulinemia and lipid abnormalities (2). A positive effect of metformin is proved by several studies on both metabolic and reproductive aspects in PCOS women (9). Metformin reduces obesity and decreases serum c-reactive protein levels in PCOS women (10). Pioglitazone is a thiazolidinedione (TZD) with hypoglycemic (anti-hyperglycemic, antidiabetic) action in the management of diabetes. It is also useful for reducing the cardiovascular risks associated with polycystic ovarian syndrome, having both anti-inflammatory and anti-arteriosclerotic properties (3). Pioglitazone was suggested to reduce the incidence of diabetes mellitus by more than 50% with administration of pioglitazone in PCOS (3). Interestingly, the protection from developing diabetes mellitus in these patients remained even when pioglitazone was stopped (3).