Efficacy of metformin on ovulation induction in Asian women with polycystic ovary syndrome

Abstract

The aim of this study was to assess the efficacy of metformin on induction of ovulation in Asian women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). Twenty PCOS women who did not respond to CC were enrolled in the study. All received 500-1500 mg/day of metformin for 4 weeks. If no dominant follicle was observed with monitoring by transvaginal ultrasound, 50-150 mg of CC per day for 5 days were added. Timing of sexual intercourse was determined or intrauterine insemination was carried out 36 h after administration of human chorionic gonadotropin. A total of six cycles, pregnancy or anovulation despite taking 150 mg of CC were considered as completion of the study. Blood samples were obtained before and at the end of the 4th week of treatment for hormonal assay. Ovulation was observed in 68 (89.5%) of 76 cycles, of which 34 (44.7%) occurred with metformin alone. Twelve women conceived; therefore, the pregnancy rate was 17.6% per ovulated cycle and 60% per woman. One (8.3%) had an abortion. Four women had minimal adverse effect, but one experienced a severe gastrointestinal effect during the fourth cycle. Insulin and androstenedione levels were significantly decreased after 4 weeks of treatment. In conclusion, these series demonstrated the excellent efficacy of metformin on induction of ovulation and pregnancy in Asian women with CC-resistant PCOS.

Metformin prevents embryonic resorption induced by hyperandrogenisation with dehydroepiandrosterone in mice

“…We can therefore propose that our results suggest an indirect effect of metformin both in the implantation process (by restoring serum E levels) and in corpus luteum development (by protecting the diminution of P levels). Moreover, previous reports have demonstrated the efficacy of metformin in regulating the hormonal pattern in women displayed during the hyperandrogenic process as PCOS (Vandermolen et al 2001;Harborne et al 2003b;Kazerooni and Dehghan-Kooshkghazi 2003;Weerakiet et al 2004;Kumari et al 2005). However, even when the hormonal environment is regulated and women with PCOS become pregnant after the induction of ovulation, they can develop defects in the luteal phase resulting in miscarriage (Homburg et al 1988), probably due to premature luteolysis.…”

Ovarian reserve in women with polycystic ovary syndrome who underwent laparoscopic ovarian drilling

“…However, only 21 of these women accepted to take part in the study. In our institute, 10-15 sites per ovary with a monopolar current probe were punctured in the LOD process [8].…”

“…Not only does it have good results with ovulation and pregnancy rates of 83-89% and 70-80% respectively [6][7][8], but it also has several advantages including having a long-term effect after one operation, inducing one follicle ovulation, not needing extensive monitoring, and having no ovarian hyperstimulation syndrome [9]. However, this method has some disadvantages including risks from anesthesia and operative complications [9].…”

Laparoscopic electrocautery of the ovaries in patients with clomiphene citrate-resistant polycystic ovary syndrome

“…So far, twelve uncontrolled studies have been published on laparoscopic electrocautery concerning ovulation and pregnancy in patients with clomiphene citrate-resistant polycystic ovary syndrome [4,[13][14][15][16][17][18][19][20][21][22][23]. Summary of the data from these studies results in a mean ovulation rate of approximately 73% (range 52-94) per patient and a mean pregnancy rate of approximately 50% (range 20-80) per patient.…”

“…Additional treatment with clomiphene citrate after laparoscopic electrocautery of the ovaries increased the ovulation rate to 87% (range 76-100) and the pregnancy rate to 70% (range 20-73) [4,5,13,18,21,22].…”