How does metformin help for PCOS?

Authors:

Stadtmauer LA. Toma SK. Riehl RM. Talbert LM.

Institution:

Dr. L. A. Stadtmauer, North Carolina "center", Reproductive Medicine, 400 Ashville Avenue, Cary, NC 27511; United States. Title Metformin treatment of patients with polycystic ovary syndrome undergoing in vitro fertilization improves outcomes and is associated with modulation of the insulin-like growth factors (2001-3247).

Source:

Fertility and Sterility. Vol 75(3) (pp05-509), 2001. Abstract

Objectives:

To determine if metformin therapy improves in vitro fertilization (IVF) outcomes in patients with clomiphene-resistant polycystic ovarian syndrome (PCOS).

Design:

Retrospective data analysis of selective groups of patients.

Setting:

A private IVF unit.

Patients:

Forty-six women with clomiphene citrate-resistant PCOS underwent 60 cycles of IVF embryo transfer with intracytoplasmic sperm injection.

Interventions:

In half of the cycles, patients received metformin (1000 to 1500 mg) daily, starting the cycle prior to gonadotropin treatment.

Main Outcome Measure(s):

Total number of follicles; serum estradiol (E2) on the day of hCG administration and the cycle's E2 maximum; total number of oocytes, mature oocytes, embryos, fertilization, and pregnancy rates; and follicular fluid levels of insulin-like growth factors (IGF-I, IGF-II) and IGF-binding proteins (IGFBP-1, IGFBP-3).

Results:

In patients treated with metformin, the total number of follicles on the day of hCG treatment was decreased (23 +/- 1.2 vs. 33 +/- 2.6) with no change in follicles >=14 mm in diameter (21 +/- 1.2 vs. 25 +/- 1.7). Metformin treatment did not affect the mean number of oocytes retrieved (22 +/- 1.9 vs. 20.3 +/- 1.5). However, the mean number of mature oocytes (18.4 +/- 1.5 vs. 13 +/- 1.5) and embryos cleaved (12.5 +/- 1.5 vs. 5.9 +/- 0.9) were increased after metformin treatment. Fertilization rates (64% vs. 43%) and clinical pregnancy rates (70% vs.30%) were also increased. Metformin led to modulation of preovulatory of follicular fluid IGF levels with increases of IGF-I (140 +/- 8 vs. 109 +/- 7ng/mL) and decreased of IGFBP-1 (133 +/- 8 vs.153 +/- 9ng/mL).

Conclusion(s):

Metformin use appears to improve IVF outcomes in patients with clomiphene citrate-resistant PCOS. Copyright (copyright) 2001 American Society for Reproductive Medicine.

See Also:

PCOS - Polycystic Ovary Syndrome

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