In a nutshell
This review looked at insulin sensitivity (IS) and its impact in fertility for women with polycystic ovarian syndrome (PCOS). It found that improving IS led to higher pregnancy rates in these women.
PCOS is a collection of signs and symptoms that affects hormonal health and metabolism in women. PCOS often involves higher levels of testosterone and irregular menses. Women with PCOS ovulate infrequently, so it can cause infertility.
PCOS is also connected to obesity and resistance to the hormone insulin. Insulin is responsible for controlling the level of glucose (sugar) in the blood. Some treatments for PCOS work by improving insulin sensitivity (IS). This includes metformin (Glucophage), which improves IS in the liver and the body. Metformin can make ovulation more regular for women with PCOS.
Other treatment options directly stimulate ovulation. This includes clomiphene citrate (CC; Clomid). However, CC may also improve IS for women with PCOS. It is not clear whether improving IS affects fertility for women with PCOS.
Methods & findings
This review analyzed 10 studies including women with PCOS and infertility. The interventions studied included metformin or CC. Studies also used diabetes medications such as exenatide (Byetta). They also used lifestyle changes, pre-conception birth control pills, or placebos. Patients were treated for between 3 months and 6 months, or until they became pregnant.
Five studies used homeostatic model assessment for insulin resistance (HOMA-IR). This model estimates IS based on fasting insulin and glucose levels. Other studies reported glucose or insulin levels.
There was an increase in pregnancy rates in women who had significant improvements in IS after treatment. There was more of an improvement in pregnancy when the patients did not have severe obesity.
The bottom line
This study found that improving IS also improves pregnancy rates in women with PCOS.
The fine print
The review could not combine data from different studies. More studies are needed to confirm these results.
Published By :
Frontiers in Endocrinology
Apr 17, 2021