The use of metformin in the management of polycystic ovary syndrome and associated anovulatory infertility: the current evidence.

Women suffering from anovulatory infertility are frequently diagnosed with polycystic ovary syndrome (PCOS), which is a varied condition of ovarian dysfunction characterised by hyperandrogenaemia and abnormal ovarian morphology. PCOS has been associated with insulin resistance, leading to the insulin-sensitising agent, metformin, being investigated as a useful therapy for the reinstatement of normal ovarian function and regular ovulation. While some trials and meta-analyses have produced very positive results with regard to improved ovulation rates in PCOS patients, this trend has not been universal and there has been some criticism of the acceptance of metformin as a first-line agent for PCOS. It is possible that metformin is more effective in certain patients, a hypothesis supported by the heterogeneous nature of the condition. This paper provides an overview of PCOS, reviews relevant literature regarding metformin and PCOS related infertility and discusses patient selection prior to instigating treatment.