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Human Reproduction Update Advance Access published online on May 5, 2005
Human Reproduction Update, doi:10.1093/humupd/dmi015
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received March 13, 2005
Revised April 15, 2005
Accepted April 17, 2005

Review

Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome

M.A. Checa 1*, A. Requena 2, C. Salvador 3, R. Tur 4, J. Callejo 3, J.J. Espinós 5, F. Fábregues 6, J. Herrero. 7, and (Reproductive Endocrinology Interest Group of the Spanish Society of Fertility)

1 Department of Obstetrics and Gynecology, Hospital Universitari del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
2 IVI--Madrid, Madrid, Spain
3 Servei d'Obstetricia i Ginecologia, Hospital de Sant Joan de Déu, Espulgues del Llobregat, Universitat de Barcelona, Barcelona, Spain, Barcelona
4 Servei de Medicina de la Reproducció, Institut Universitari Dexeus, Universitat Autónoma de Barcelona, Barcelona, Spain
5 Servei d'Obstetricia i Ginecologia, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain, Barcelona
6 Servei de Ginecologia, Hospital Clínic, Universitat de Barcelona,, Barcelona, Spain Barcelona and
7 Servei de Ginecologia, Hospital Materno-infantil Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain

* To whom correspondence should be addressed.
M.A. Checa, E-mail: macheca{at}imas.imim.es


  Abstract

Treatment with insulin-sensitizing agents is a relatively recent therapeutic strategy in women with polycystic ovary syndrome (PCOS) and insulin resistance. The key areas addressed in this review include PCOS and the development of type 2 diabetes mellitus and gestational diabetes, as well as the use of insulin-sensitizing agents, particularly metformin, in the management of infertility in obese and non-obese PCOS women. Treatment with metformin in PCOS women undergoing IVF and the use of metformin during gestation will be discussed. The challenge for the health care professional should be the appropriate utilization of pharmacotherapies to improve insulin sensitivity and lower circulating insulin levels resulting in beneficial changes in PCOS phenotype. Further research into the potential role of other insulin-sensitizing agents, such as pioglitazone and rosiglitazone, in the treatment of infertile women with PCOS is needed.

Keywords: diabetes; insulin-sensitizing agents; metformin; obesity; polycystic ovary syndrome.

*Authorship credit should be equally distributed among the authors independently of the order.


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