In a nutshell
This analysis looked at the effects of metformin (Glucophage) for women with polycystic ovarian syndrome (PCOS) who are undergoing in vitro fertilization (IVF). It found that metformin lowers the risk of ovarian hyperstimulation syndrome (OHSS), and may increase pregnancy rates for those who are overweight.
PCOS is a condition where women do not ovulate regularly and have high testosterone levels. It is more common for women with obesity. PCOS is a common cause of female infertility. PCOS may be linked to resistance to the hormone insulin, which controls levels of glucose (sugar) in the blood.
Metformin is a medication that slows the absorption of glucose from food. Metformin is used to treat insulin resistance and is often used for women with PCOS. Some studies have found that metformin can improve pregnancy rates during IVF. However, other studies have not found an improvement.
Women with PCOS are also at higher risk of OHSS, in which the ovaries respond too strongly to IVF medications. OHSS causes pain and swelling in the ovaries and carries a risk of more serious complications. It is not clear whether metformin can reduce the risk of OHSS for women with PCOS while undergoing IVF.
Methods & findings
This analysis used the results of 12 studies with 1123 women with PCOS. All patients were undergoing IVF or a related procedure, intracytoplasmic sperm injection (ICSI). Patients were randomly assigned to take metformin or a placebo (inactive pill).
Women using metformin had a significantly lower risk of OHSS (57% lower odds). For women who had PCOS and were overweight (body mass index over 26 kg/m²), metformin reduced the odds of OHSS by 75%.
No overall relationship was found between metformin and pregnancy rates. However, for women who were overweight with PCOS, metformin led to a significant increase in pregnancies (71% higher odds).
The bottom line
This analysis found that metformin reduces the risk of OHSS for women with PCOS undergoing IVF. For women who are overweight, it also found that metformin increases pregnancy rates.
The fine print
These findings are based on high-quality evidence, which means they are unlikely to change in the future.
Published By :
JAMA network open
Aug 03, 2020