Human Reproduction Update Advance Access originally published online on September 1, 2007
Human Reproduction Update 2007 13(6):527-537; doi:10.1093/humupd/dmm026
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The role of metformin in polycystic ovary syndrome: a systematic review
Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
1 Correspondence address. Tel: +31-20-5663557; Fax: +31-20-6963489; E-mail: e.moll{at}amc.uva.nl
This meta-analysis evaluated the effectiveness of metformin in subfertile women with polycystic ovary syndrome (PCOS). Only randomized trials investigating the effectiveness of metformin and PCOS definition consistent with the Rotterdam consensus criteria, were eligible. Primary outcome was live birth rate. A literature search identified 27 trials. In therapy naïve women, we found no evidence of a difference in live birth rate when comparing metformin with clomifene citrate (CC) [relative risks (RR) 0.73; 95% confidence interval (CI) 0.51–1.1] or comparing metformin plus CC with CC (RR 1.0; 95% CI 0.82–1.3). In CC-resistant women, metformin plus CC led to higher live birth rates than CC alone (RR 6.4; 95% CI 1.2–35); metformin also led to higher live birth rates than laparoscopic ovarian drilling (LOD) (RR 1.6; 95% CI 1.1–2.5). We found no evidence for a positive effect of metformin on live birth when added to LOD (RR 1.3; 95% CI 0.39–4.0) or FSH (RR 1.6; 95% CI 0.95–2.9), or when co-administered in IVF (RR 1.5; 95% CI 0.92–2.5). In IVF, metformin led to fewer cases of ovarian hyperstimulation syndrome (OHSS) (RR 0.33; 95% CI 0.13–0.80). This meta-analysis demonstrates that CC is still first choice therapy for women with therapy naïve PCOS. In CC-resistant women, the combination of CC plus metformin is the preferred treatment option before starting with LOD or FSH. At present, there is no evidence of an improvement in live birth when adding metformin to LOD or FSH. In IVF, metformin leads to a reduced risk of OHSS.
Key words: infertility / metformin / PCOS / pregnancy / review
Received on April 12, 2007; revised June 7, 2007; accepted on June 29, 2007
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. E. Rausch, R. S. Legro, H. X. Barnhart, W. D. Schlaff, B. R. Carr, M. P. Diamond, S. A. Carson, M. P. Steinkampf, P. G. McGovern, N. A. Cataldo, et al. Predictors of Pregnancy in Women with Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., September 1, 2009; 94(9): 3458 - 3466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Iwase, M. Goto, T. Harata, S. Takigawa, T. Nakahara, K. Suzuki, S. Manabe, and F. Kikkawa Insulin Attenuates the Insulin-Like Growth Factor-I (IGF-I)-Akt Pathway, not IGF-I-Extracellularly Regulated Kinase Pathway, in Luteinized Granulosa Cells with an Increase in PTEN J. Clin. Endocrinol. Metab., June 1, 2009; 94(6): 2184 - 2191. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Palomba, A. Falbo, F. Zullo, and F. Orio Jr. Evidence-Based and Potential Benefits of Metformin in the Polycystic Ovary Syndrome: A Comprehensive Review Endocr. Rev., February 1, 2009; 30(1): 1 - 50. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Palomba and A. Falbo Metformin in therapy naive patients with polycystic ovary syndrome Hum. Reprod. Update, March 1, 2008; 14(2): 193 - 193. [Full Text] [PDF]
|
|