Does metformin improve fertility outcomes in polycystic ovarian syndrome (PCOS) patients undergoing ovulation induction?

This study investigated if co-treatment with metformin improved fertility outcomes in patients with polycystic ovarian syndrome (PCOS).

They found that metformin co-treatment was associated with a higher birth rate and higher pregnancy rates in PCOS patients.

Women with PCOS can experience fertility problems and may not ovulate regularly. The first line of treatment is clomiphene citrate (CC) which stimulates ovulation. Some patients, however, are resistant to CC. Alternatively, women can be treated with follicle stimulating hormone (FSH) which will also stimulate ovulation.

Recent evidence has shown a link between insulin resistance and absence of ovulation. Metformin is a drug that can increase insulin sensitivity. There is evidence to suggest that it may improve the chances of pregnancy in women with PCOS. 

This study analyzed results from 5 clinical trial reports. These studies included 264 women who were resistant to CC, receiving FSH with or without metformin. The number of reported live births, ongoing pregnancies and clinical pregnancies were recorded.

Metformin treatment was associated with a 2.31-fold increase in the odds of a live birth. The odds of an ongoing pregnancy were 2.46 times higher. In patients receiving metformin co-treatment, the clinical pregnancy rate was 45% compared to 25% in those not receiving metformin. There were no significant adverse effects as a result of metformin treatment. 

This study concluded that metformin improved fertility outcomes in patients with PCOS. 

The authors acknowledge the data is of low quality, as it was difficult to compare all parameters equally across the studies. Further studies required to properly assess any long-term adverse effects.

If you have been diagnosed with PCOS and trying to conceive than you may want to discuss fertility treatment strategies with your physician.