Adriana Leal Griz Notaro1, Filipe Tenorio Lira Neto2. 1. Amare Clinic - Brazil, Av. República do Líbano, n 251, torre 1, sala 504, Pina, Recife, PE, CEP 51110-160, Brazil. 2. Andros Recife Clinic - Brazil, Av. Boa Viagem, n 179, apt 901, Pina, Recife, PE, CEP 51011-000, Brazil. ftenorio.uro@gmail.com.
Abstract
PURPOSES: Polycystic ovary syndrome (PCOS) is a major cause of female infertility, being present in up to 20% of women of childbearing age. Insulin resistance (IR) plays an important role in the pathophysiology of PCOS; therefore, its treatment may benefit women with the syndrome. The main drug used for IR management is metformin (MT). We aim to review the literature on the use of metformin in women with PCOS. METHODS: Using the terms "metformin" and "polycystic ovary syndrome," we conducted a search the PubMed, EMBASE, and Google Scholar databases. The research was restricted to articles published in English. Initially, only published meta-analyses were included, in the absence of meta-analyzes, RCT and well-designed prospective studies were used. RESULTS: Metformin increases success rates and decreases complication rates when used as an adjunctive medication for ovulation induction during low complexity assisted reproduction treatments and during ovarian stimulation for in vitro fertilization in women with PCOS. Evidence about the effect of metformin on fetal and obstetric complication rates is conflicting. Metformin is associated with high incidence of gastrointestinal symptoms; however, serious adverse effects are rare and there is no evidence of teratogenicity. CONCLUSION: For women with PCOS, metformin is a good adjunctive medication for ovulation induction/stimulation for high and low complexity assisted reproduction therapies. The adverse effects are mostly mild, and there is no risk of teratogenicity, but the risk of long-term complications for the offspring is not yet defined. High heterogeneity of the studies limits extrapolation of findings, and further research is needed to determine which women will benefit most from the medication.
PURPOSES: Polycystic ovary syndrome (PCOS) is a major cause of female infertility, being present in up to 20% of women of childbearing age. Insulin resistance (IR) plays an important role in the pathophysiology of PCOS; therefore, its treatment may benefit women with the syndrome. The main drug used for IR management is metformin (MT). We aim to review the literature on the use of metformin in women with PCOS. METHODS: Using the terms "metformin" and "polycystic ovary syndrome," we conducted a search the PubMed, EMBASE, and Google Scholar databases. The research was restricted to articles published in English. Initially, only published meta-analyses were included, in the absence of meta-analyzes, RCT and well-designed prospective studies were used. RESULTS: Metformin increases success rates and decreases complication rates when used as an adjunctive medication for ovulation induction during low complexity assisted reproduction treatments and during ovarian stimulation for in vitro fertilization in women with PCOS. Evidence about the effect of metformin on fetal and obstetric complication rates is conflicting. Metformin is associated with high incidence of gastrointestinal symptoms; however, serious adverse effects are rare and there is no evidence of teratogenicity. CONCLUSION: For women with PCOS, metformin is a good adjunctive medication for ovulation induction/stimulation for high and low complexity assisted reproduction therapies. The adverse effects are mostly mild, and there is no risk of teratogenicity, but the risk of long-term complications for the offspring is not yet defined. High heterogeneity of the studies limits extrapolation of findings, and further research is needed to determine which women will benefit most from the medication.
Authors: Rui Wang; Wentao Li; Esmée M Bordewijk; Richard S Legro; Heping Zhang; Xiaoke Wu; Jingshu Gao; Laure Morin-Papunen; Roy Homburg; Tamar E König; Etelka Moll; Sujata Kar; Wei Huang; Neil P Johnson; Saad A Amer; Walter Vegetti; Stefano Palomba; Angela Falbo; Ülkü Özmen; Hakan Nazik; Christopher D Williams; Grasso Federica; Jonathan Lord; Yilmaz Sahin; Siladitya Bhattacharya; Robert J Norman; Madelon van Wely; Ben Willem Mol Journal: Hum Reprod Update Date: 2019-11-05 Impact factor: 15.610
Authors: Marie L Misso; Michael F Costello; Marie Garrubba; Jennifer Wong; Roger Hart; Luk Rombauts; Angela M Melder; Robert J Norman; Helena J Teede Journal: Hum Reprod Update Date: 2012-09-06 Impact factor: 15.610
Authors: Ricardo Azziz; Enrico Carmina; ZiJiang Chen; Andrea Dunaif; Joop S E Laven; Richard S Legro; Daria Lizneva; Barbara Natterson-Horowtiz; Helena J Teede; Bulent O Yildiz Journal: Nat Rev Dis Primers Date: 2016-08-11 Impact factor: 52.329