Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Controlled Trial

Abstract

Short-term administration of metformin to overweight or obese women with PCOS undergoing IVF decreased number of the retrieved oocytes but did not improve the LBR. Synopsis Metformin use could decrease the number of retrieved oocytes in overweight and obese women with polycystic ovary syndrome undergoing IVF.

Association of Metformin With Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome Undergoing In Vitro Fertilization

“… 14 , 16 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 After full-text assessment, 1 article was excluded because participants did not meet the inclusion criteria, 1 article was excluded because it did not have a parallel control and had incomplete outcomes, and 1 article was excluded because it did not report findings in English (eTable 3 in the Supplement ). Finally, 12 RCTs 14 , 16 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 were included in the meta-analysis. In total, 1123 women with PCOS were randomized, with 564 (50.2%) to metformin and 559 (49.8%) to control.…”

“…Main characteristics and specific interventions of included studies are presented in eTable 1 and eTable 2 in the Supplement . Eight studies 14 , 16 , 22 , 24 , 25 , 26 , 28 , 31 reported the full outcomes (ie, OHSS rate, clinical pregnancy rate, and live birth rate). One study 30 did not report OHSS incidence; 1 study 29 did not report clinical pregnancy rates; and 4 studies 23 , 27 , 29 , 30 did not report live birth rates.…”

“…One study 30 did not report OHSS incidence; 1 study 29 did not report clinical pregnancy rates; and 4 studies 23 , 27 , 29 , 30 did not report live birth rates. Only 4 studies 14 , 16 , 27 , 30 reported miscarriage rates.…”

“…Eleven studies 14 , 16 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 31 reported the OHSS rate, and 1 study 30 reported the incidence of OHSS as 0 in both metformin and control groups. In the studies included in the analysis, 10 studies 14 , 16 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 used long gonadotropin-releasing hormone–agonist stimulation protocol, and the others 22 , 29 used gonadotropin-releasing hormone–antagonist protocol. Women in the metformin group had lowers odds of OHSS than women in the control group (11 RCTs; 947 participants; OR, 0.43; 95% CI, 0.24-0.78; I 2 = 38%; P = .005) ( Figure 3 A).…”

“…Several randomized clinical trials (RCTs) demonstrated that metformin was associated with a significantly higher ovulation rate compared with placebo, 12 , 13 but other studies have shown the opposite result. 14 Moreover, multiple RCTs assessed the role of metformin in clinical pregnancy, live birth rates, and first trimester spontaneous abortion rates and observed the risk of ovarian hyperstimulation syndrome (OHSS). Similarly, many studies showed improved clinical pregnancy and live birth rates, 11 , 15 , 16 improved rates of miscarriage and implantation, and reduced risk of OHSS.…”