Metformin in the treatment of clomiphene citrate-resistant women with high BMI and primary infertility: Clinical results and reproductive outcome

Abstract

The objective of this study was to evaluate the clinical and reproductive outcome in clomiphene-citrate (CC)-resistant women with high body mass index (BMI) and primary infertility. This was a case series based at the King Hussein Medical center, Amman, Jordan. Nineteen CC-resistant women with polycystic ovary syndrome (PCOS) who had high BMI and primary infertility were studied. All women received metformin monotherapy; 850 mg twice daily for a period of 6 months. If pregnancy occurred, metformin was continued for the first 12 weeks of pregnancy. The main outcome measures were a reduction in the BMI, resumption of regular menses, ovulation and pregnancy rates. Resumption of regular cycles was observed in 13 of 19 (68.4%) women. Ovulation and pregnancy were achieved in 9 (47.4%) and 6 (31.6%) of the 19 women, respectively. A significant reduction in the body weight after treatment reflected by a significant reduction in the BMI was noted. Metformin monotherapy is effective in CC-resistant women with morbid obesity and primary infertility and should be considered as first-line treatment in these patients.

Metformin in the treatment of clomiphene citrate-resistant women with polycystic ovary syndrome undergoingin vitrofertilisation treatment: A randomised controlled trial

“…The association of insulin resistance contributing to anovulation has led to the use of metformin in women with PCOS. It has been reported that metformin ameliorates hyperinsulinaemia and reduces androgen levels and LH concentrations with subsequent improvement in the clinical features and reproductive outcome in these women (Diamanti-Kandrakis et al 1998;Moghetti et al 2000;Qublan and Malkawi 2005). Therefore, it has been hypothesised that the administration of metformin in the IVF treatment may also improve the outcome (Stadtmauer et al 2001(Stadtmauer et al , 2002Fedorcsak et al 2003;Kjotrod et al 2004).…”

“…Metformin is classified as a category B drug for use in pregnancy. It has been shown to be safe without adverse effects on the fetus (Glueck et al 2002;Qublan and Malkawi 2005). Furthermore, metformin treatment was also found to decrease the rate of early pregnancy loss (Glueck et al 2002;Jakubowicz et al 2002;Vanky et al 2004).…”

Research Article Identification of differentially expressed genes in pathways of cerebral neurotransmission of anovulatory mice.

“…It is well known that the feedback regulation of GnRH neurons by steroid hormones is critical to normal reproductive function and occurs in part through altered GABAergic drive to these cells (Qublan and Malkawi, 2005;Zafar, 2005;Rouzi et al, 2006;Freret et al, 2006;Costello et al, 2007a,b). Altered sensitivity to steroid feedback is associated with forms of hypothalamic infertility such as the common reproductive disorder PCOS, a leading cause of infertility in women.…”

Obésité et reproduction : revue de la littérature

“…La metformine agit en améliorant l'équilibre endocrinien et métabolique (diminution de l'hyperandrogénie et de l'insulinorésistance) ; elle augmente par conséquent le taux de grossesse [32] ; à la dose de 850 mg deux fois par jour en monothérapie pendant six mois, elle est recommandée en première intention chez les patientes en infertilité primaire avec une obésité morbide, résistantes au CC : elle permet de réduire l'IMC et de normaliser les cycles dans 68 % des cas, de restaurer une ovulation dans 47 % des cas et d'induire une grossesse dans 32 % des cas [33]. Un bénéfice peut éventuellement être attendu chez les patientes OPK d'une manière générale puisqu'en cas de résistance au CC, l'adjonction de metformine ( …”

“…Comme constaté dans une étude précédemment citée, la metformine en monothérapie (850 mg deux fois par jour durant six mois chez des patientes avec obésité morbide) permet une perte de poids associée à une amélioration des désordres endocriniens et métaboliques, et une amélioration de la fertilité [33]. D'autres traitements médicamenteux de l'obésité existent : la sibutramine agit comme inhibiteur de la recapture de la sérotonine et de la noradrénaline ; le xenical diminue l'absorption intestinale des graisses en inhibant les lipases pancréatiques.…”