The efficacy of pioglitazone is greater than that of metformin for in vitro fertilization (IVF) cycles in infertility associated with polycystic ovarian syndrome (PCOS), according to a recent study published in Annals of Medicine & Surgery.
Takeaways
- Pioglitazone shows superior efficacy over metformin in improving clinical pregnancy rates among polycystic ovarian syndrome (PCOS) patients undergoing in vitro fertilization (IVF), as per a recent study.
- PCOS-associated infertility poses challenges during controlled ovarian stimulation, impacting oocyte quality and ovulation.
- The study, conducted as a double-blind, randomized clinical trial, focused on patients aged under 39 years with clomiphene citrate-resistant PCOS and previous IVF failure.
- Both pioglitazone and metformin were administered to respective groups, with pioglitazone showing a significantly higher positive pregnancy rate.
- While pioglitazone demonstrated higher pregnancy rates, the choice between pioglitazone and metformin might not affect the number of retrieved oocytes or implanted embryos.
Approximately 5% to 20% of reproductive-aged women experience PCOS, with common symptoms including elevated serum androgen levels, anovulatory cycle signs, and infertility. PCOS-associated infertility leads to many complications related to controlled ovarian stimulation, including decreased oocyte quality and ovulation.
PCOS is influenced by environmental, genetic, and transgenerational factors. Estrogen and progesterone have historically been used to treat the condition, but the role of insulin resistance in PCOS has led to suggestions that it can be effectively treated using insulin sensitizers including pioglitazone and metformin.
To evaluate the efficacy of pioglitazone and metformin in IVF among patients with PCOS-associated infertility, investigators conducted a double-blind, randomized clinical trial. The clinical pregnancy rate, determined by the presence of a gestational sac with fetal heartbeat during ultrasound, was reported as the primary outcome of the analysis.
Secondary outcomes included oocyte quality and quantity, number of embryos following fertilization, and assessments of various hormone levels. Participants were aged under 39 years and had clomiphene citrate-resistant-PCOS and one-time IVF failure. Rotterdam criteria was used to identify patients with PCOS.
Exclusion criteria included endometriosis, hydrosalpinx, being aged over 39 years, having at least 2 IVF-failures, husband with infertile semen, severe malefactor requiring biopsy, and not following the medication protocol. Participants were randomized 1:1 to receive pioglitazone or metformin.
Patients in the case group received 15 mg pioglitazone twice per day for 6 weeks leading up to IVF, while those in the control group received 1000 mg metformin twice per day. Efficacy was determined based on rates of successful pregnancy.
There were 86 participants in each group, aged a mean 32.12±3.9 in the case group and 32.09±3.9 years in the control group. Similar levels of follicle-stimulating hormone, luteinizing hormone, anti-müllerian hormone, prolactin, estrogen, and progesterone were reported between groups.
In the case group, a mean 11.86±3.7 IVF eggs were retrieved and 7.87±3.5 were formed. These numbers were 11.76±3.7 and 7.43±2.8, respectively, in the control group. A significantly increased positive pregnancy rate was reported in the case group vs the control group, at 48.8% and 32.6%, respectively.
These results indicated increased efficacy from pioglitazone vs metformin before IVF for achieving pregnancy among patients with PCOS. Investigators noted that the choice of pioglitazone vs metformin may not impact the number of oocytes retrieved and embryos implanted.
Reference
Taheripanah R, Kazemi SN, Taheripanah A, Fereidoonjah S. A randomized controlled trial comparing pioglitazone and metformin prior to in vitro fertilization in polycystic ovary syndrome – associated infertile women: impact on pregnancy rates. Annals of Medicine & Surgery. 2024;86(5):2696-2701. doi:10.1097/MS9.0000000000001816
