Metformin improves pregnancy rate among women with PCOS, overweight
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Women with polycystic ovary syndrome and overweight or obesity who underwent fertility treatment had a higher clinical pregnancy rate when assigned metformin vs. similar women not taking the medication, according to a meta-analysis.
“The findings of this study suggest metformin treatment should be carefully considered for women with PCOS undergoing in vitro fertilization and may be more recommended for women with a BMI of 26 kg/m² or greater,” Dan Zhang, MD, PhD, professor of obstetrics and gynecology and attending physician of reproductive endocrinology at Women's Hospital, Zhejiang University School of Medicine, China, told Healio. “Long-term randomized controlled trials following up on the health of offspring are needed to provide more information of metformin and offspring health, especially metabolic status.”
In a meta-analysis published in JAMA Network Open, Zhang and colleagues analyzed data from 12 randomized controlled trials with 1,123 women with PCOS undergoing fertility treatment with IVF, intracytoplasmic sperm injection and embryo transfer. All studies used metformin as an intervention (564 women received metformin); no participants had diabetes. Outcome measures were risk for ovarian hyperstimulation syndrome, clinical pregnancy rate, live birth rate and miscarriage rate. Researchers used random-effects models to estimate ORs for outcomes among women based on metformin treatment.
The risk for ovarian hyperstimulation syndrome in women who received metformin was lower compared with women who did not receive metformin (OR = 0.43; 95% CI, 0.24-0.78); however, the difference was not significant for women with PCOS with a BMI of 26 kg/m² or lower (OR = 0.67; 95% CI, 0.3-1.51).
Researchers did not observe between-group differences in clinical pregnancy rate or live birth rate; however, in a post hoc analysis among women with a BMI of at least 26 kg/m², metformin treatment was associated with increased clinical pregnancy rates (OR = 1.71; 95% CI, 1.12-2.6).
“This meta-analysis showed metformin treatment was associated with a decreased risk of ovarian hyperstimulation syndrome but had no association with the overall clinical pregnancy rate or live birth rate among women with PCOS undergoing IVF, intracytoplasmic sperm injection and embryo transfer,” the researchers wrote. “For women with a BMI of 26 [kg/m²] or greater, metformin treatment was associated with an increased clinical pregnancy rate. Metformin treatment should be carefully considered for women with PCOS undergoing IVF, intracytoplasmic sperm injection and embryo transfer and may be more preferred among women with a BMI of 26 [kg/m²] or greater.”
For more information:
Dan Zhang, MD, PhD, can be reached at Women's Reproductive Health Research Key Laboratory of Zhejiang Province, Women's Hospital, Department of Reproductive Endocrinology, Zhejiang University School of Medicine, No. 1 Xueshi Road, Hangzhou 310006, PR, China; email: zhangdan@zju.edu.cn.
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