Metformin polycystic ovarian
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Summary
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Some studies suggest metformin improves clinical pregnancy rates, ovulation rates, and metabolic parameters in women with PCOS, while other studies indicate it does not significantly improve live birth rates or outcomes during IVF/ICSI.
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The Role of Metformin in Treating Polycystic Ovary Syndrome (PCOS)
Introduction to PCOS and Metformin
Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by anovulation, hyperandrogenism, and insulin resistance. Women with PCOS often experience irregular menstrual cycles, infertility, and metabolic issues such as hyperinsulinemia and increased risk of diabetes mellitus . Metformin, an insulin-sensitizing agent, has been widely studied for its potential benefits in managing PCOS symptoms and improving reproductive outcomes.
Metformin for Ovulation Induction
Metformin vs. Placebo
Research indicates that metformin may improve live birth rates and clinical pregnancy rates compared to placebo in women with PCOS. Studies show that metformin increases the likelihood of ovulation and clinical pregnancy, although it is associated with higher rates of gastrointestinal side effects . Specifically, metformin has been shown to improve live birth rates (OR 1.59) and clinical pregnancy rates (OR 1.98) compared to placebo.
Metformin Combined with Clomiphene Citrate (CC)
When combined with clomiphene citrate (CC), metformin may enhance clinical pregnancy rates and ovulation rates compared to CC alone. However, the evidence on live birth rates remains inconclusive. The combination therapy is also associated with increased gastrointestinal side effects . For instance, metformin plus CC showed higher clinical pregnancy rates (OR 1.62) and ovulation rates (OR 1.65) compared to CC alone.
Metformin vs. Clomiphene Citrate
Comparing metformin directly with CC, the results are mixed. Some studies suggest that metformin may be less effective in obese women but potentially beneficial in non-obese women. Overall, the evidence is inconclusive regarding live birth rates, with significant variability based on body mass index (BMI) .
Metformin in Assisted Reproductive Techniques (ART)
IVF and ICSI
Metformin has been studied as a co-treatment during in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. The evidence suggests that metformin may reduce the incidence of ovarian hyperstimulation syndrome (OHSS) but does not conclusively improve live birth rates. In long protocol GnRH-agonist cycles, metformin may increase clinical pregnancy rates, while in short protocol GnRH-antagonist cycles, it may reduce live birth rates.
Metformin and Lifestyle Modifications
Combining metformin with lifestyle modifications, such as diet and exercise, has shown benefits in reducing BMI, subcutaneous adipose tissue, and improving menstrual cyclicity in women with PCOS. This combination appears to be more effective than lifestyle modifications alone. Metformin alone also showed improvements in hyperandrogenism and menstrual regularity, particularly in non-obese women.
Long-term Effects and Safety
Long-term studies indicate that metformin can sustain improvements in menstrual regularity and ovulation in women with PCOS. It reduces hyperinsulinemia and hyperandrogenemia without significant changes in body weight. However, gastrointestinal disturbances are common, and the long-term safety of metformin in young women remains to be fully established.
Conclusion
Metformin is a valuable treatment option for managing PCOS, particularly in improving ovulation and clinical pregnancy rates. Its effectiveness varies based on individual factors such as BMI and whether it is used alone or in combination with other treatments like clomiphene citrate. While metformin shows promise in reducing OHSS in ART and improving metabolic profiles, its impact on live birth rates remains inconclusive. Combining metformin with lifestyle modifications may offer additional benefits, emphasizing the need for personalized treatment approaches in women with PCOS.
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