Samuel S Thatcher1, Elizabeth M Jackson. 1. Center for Applied Reproductive Science, Johnson City, Tennessee 37604-6088, USA. thatcher@ivf-et.com
Abstract
OBJECTIVE: To analyze pregnancy complications and outcome in patients with polycystic ovary syndrome (PCOS) treated with metformin. DESIGN: Single center retrospective case analysis. SETTING: Private regional nonurban referral subspecialty practice. PATIENT(S): After 7 months of average metformin use, 188 patients with PCOS (average infertility: 27 months) achieved 237 pregnancies. INTERVENTION(S): Of pregnancies established, metformin alone was used before conception in 124/237 (52%), oral fertility agents (CC or letrozole) in 81 (34%), gonadotropin therapy in 7 (3.0%), assisted reproduction in 17 (7.2%), and other fertility-promoting regimens in 8 (3.4%). MAIN OUTCOME MEASURE(S): Analysis of prepregnancy health parameters (weight, blood pressure, glucose tolerance, fasting and stimulated insulin levels) and pregnancy outcomes (miscarriage, pregnancy length, hypertension, gestational diabetes, weight gain, birth weight, sex ratio, congenital malformations, and breastfeeding success). RESULT(S): Metformin appears to decrease the rate of spontaneous abortion. The co-morbidities of PCOS including obesity, insulin resistance, and glucose sensitivity served as indicators of increased risk for pregnancy complications, especially gestational diabetes. No increase in pregnancy-induced hypertension was evident. Prematurity was increased. Neither PCOS nor metformin use appears to increase the rate of congenital anomaly. PCOS did not affect lactation. CONCLUSION(S): PCOS or its co-morbidities are associated with poorer pregnancy outcome. Implications and interventions are discussed.
OBJECTIVE: To analyze pregnancy complications and outcome in patients with polycystic ovary syndrome (PCOS) treated with metformin. DESIGN: Single center retrospective case analysis. SETTING: Private regional nonurban referral subspecialty practice. PATIENT(S): After 7 months of average metformin use, 188 patients with PCOS (average infertility: 27 months) achieved 237 pregnancies. INTERVENTION(S): Of pregnancies established, metformin alone was used before conception in 124/237 (52%), oral fertility agents (CC or letrozole) in 81 (34%), gonadotropin therapy in 7 (3.0%), assisted reproduction in 17 (7.2%), and other fertility-promoting regimens in 8 (3.4%). MAIN OUTCOME MEASURE(S): Analysis of prepregnancy health parameters (weight, blood pressure, glucose tolerance, fasting and stimulated insulin levels) and pregnancy outcomes (miscarriage, pregnancy length, hypertension, gestational diabetes, weight gain, birth weight, sex ratio, congenital malformations, and breastfeeding success). RESULT(S): Metformin appears to decrease the rate of spontaneous abortion. The co-morbidities of PCOS including obesity, insulin resistance, and glucose sensitivity served as indicators of increased risk for pregnancy complications, especially gestational diabetes. No increase in pregnancy-induced hypertension was evident. Prematurity was increased. Neither PCOS nor metformin use appears to increase the rate of congenital anomaly. PCOS did not affect lactation. CONCLUSION(S): PCOS or its co-morbidities are associated with poorer pregnancy outcome. Implications and interventions are discussed.
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