Metformin in Women With Polycystic Ovary Disease

Lowering insulin levels with metformin in women with polycystic ovary syndrome but without overt diabetes increases the likelihood of conception and reduces risk of miscarriage, researchers report here.

Dr. Scott Sills of the Atlanta Reproductive Health Center in Georgia spoke with Reuters Health at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society. He indicated that all 20 patients with polycystic ovary syndrome who had been evaluated by the team for infertility became pregnant within a median period of 3 months following the introduction of metformin therapy. To date, 12 infants have been delivered in the group.

"No patient was diabetic and polycystic ovary syndrome was established as the only infertility factor in all patients prior to treatment," Dr. Sills reported.

Time to conception was longer and miscarriage rates were higher in women with a body mass index in excess of 32. In this group, pregnancy losses was as high as 40% compared with 10% in women who had a body mass index of less than 32. As a consequence, prolonged treatment with metformin was necessary in heavier women before pregnancy could be achieved, Dr. Sills noted.

Except for a single patient who underwent artificial insemination, "...treatment was followed by timed intercourse in all cycles," the Atlanta team reports. Two patients also received Decadron to reduce androgen levels, while three patients underwent "ovarian drilling."

"Historically, the two major approaches to managing polycystic ovary syndrome have been with clomiphene citrate or birth control pills, depending on whether the patient is trying to conceive or not," Dr. Sills commented. Neither of these approaches address insulin resistance, however. While metformin has no effect on ovarian function, Dr. Sills said, it
restores menstrual cycles to their normal pattern, which increases the odds of conception.

"Getting patients pregnant is not the challenge in polycystic ovary syndrome, it's keeping them pregnant," Dr. Sills said, "so I think metformin can help us with both of these goals."

Dr. Sills added that while he and his colleagues originally discontinued metformin once pregnancy was achieved, they are now recommending treatment be continued at least until fetal cardiac activity can be established on sonography.