Does metformin modify ovarian responsiveness during exogenous FSH ovulation induction in normogonadotrophic anovulation? A placebo-controlled double-blind assessment

Abstract

Objective: To assess whether the addition of metformin to gonadotrophin ovulation induction in insulin-resistant, normogonadotrophic, anovulatory women alters ovarian responsiveness to exogenous FSH. Design: Placebo-controlled double-blind assessment in an academic hospital. Results: After a progestagen withdrawal bleeding, patients were randomised for either metformin (n ¼ 11) or placebo (n ¼ 9) treatment. In cases of absent ovulation, exogenous FSH was subsequently administered to induce ovulation. Only during metformin treatment did body mass index and androgen (androstenedione and testosterone) levels decrease, whereas FSH and LH levels increased significantly. In the metformin group, a single patient ovulated before the initiation of exogenous FSH. Significantly more monofollicular cycles and lower preovulatory oestradiol concentrations were observed in women receiving FSH with metformin compared with FSH alone. Conclusions: Metformin co-treatment in a group of insulin-resistant, normogonadotrophic, anovulatory patients resulted in normalization of the endocrine profile and facilitated monofollicular development during the FSH induction of ovulation.European Journal of Endocrinology 152 611-617

Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials

“…The populations studied in the different RCTs were heterogeneous for several demographic and biochemical/metabolic characteristics. In no RCT was metformin was administered during pregnancy; its administration was always continued until achieving positive pregnancy test (22,32,34,41,42,46,51,52,55,56) or stopped at human chorionic gonadotropin (hCG) injection (36,38,40,43,45,48). However, one study provided no data in this effect regard (39).…”

Maternal physical and sedentary activities in relation to reproductive outcomes following IVF

“…For instance, regular physical activity is known to be an effective therapeutic intervention to improve glucose homeostasis and insulin sensitivity (Hawley, 2004). As insulin sensitizers seem to have beneficial effects on ovulatory function and fertility, even among women with little to no clinical evidence of polycystic ovary syndrome (Ibanez et al ., 2001; van Santbrink et al ., 2005), it is possible that improved glucose regulation is the mechanism through with physical activity is exerting its beneficial effects. Routine physical activity is also associated with improved psychological well-being, e.g.…”

Drug Insight: insulin-sensitizing drugs in the treatment of polycystic ovary syndrome—a reappraisal

“…36 Smaller studies with the currently available thiazolidinediones-pioglitazone and rosiglitazone-suggest that they have similar efficacy for ovulation induction to that of tro glitazone. 37,49,50 It has also been suggested that metformin used in conjunction with gonadotropin therapy for ovulation induction improves unifollicular development 51,52 and conception rates, and reduces ovarian hyperstimulation syndrome. 53 When clinical pregnancy rates were assessed rather than ovulation rates in the meta-analysis of ISDs, 34 only metformin in combination with clomiphene was significantly more effective than clomiphene alone.…”