Korean J Obstet Gynecol.  2003 Oct;46(10):1920-1925.

Effects of Metformin on Clomiphene-resistant Infertile Women with Polycystic Ovary Syndrome

• Moon HS
• Joo BS
• Park SH
• Song SJ
• Kim CH
• Moon SE
• Kim KS

Abstract

OBJECTIVE
The aim of this study was to evaluate the efficacy of metformin for ovualtion induction and pregnancy in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS).
METHODS
From March 2001 to March 2002, 19 patients with PCOS who had at least two consecutive cycles of anovulation in response to CC treatment up to 250 mg/day at the Infertility Center of Moon Hwa Hospital were enrolled in this study. The participants were required to have tubal patency on hysterosalpingography and their husbands were required to have normal semen analysis. The mean age was 30.5 +/- 3.6 years, the body weight 62.7 +/- 10.1 kg, the duration of infertility 3.7 +/- 2.1 years and the BMI 24.7 +/- 3.6 kg/m2. For 19 patients, a total of 75 cycles were treated with 1) CC+gonadotropin (group 1; 24 cycles), 2) CC+metformin (group 2; 29 cycles), or 3) CC+gonadotropin+metformin (group 3; 22 cycles). As for gonadotropin, highly purified-follicle stimulating hormone (HP-FSH) or/and hMG were used from the 3rd day of CC treatment. In the first cycle, metformin (1,500 mg/day) was administered during 1-28 days of menstrual cycle. Metformin was discontinued when a pregnancy was confirmed.
RESULTS
Among 19 patients, 17 patients were ovulated (89.5%) and 7 patients (36.8%) were pregnant. Of a total of 75 cycles, 51 cycles (68.0%) were ovulated successfully with one of three treatment methods. Metformin treatment had similar ovulation rate compared to gonadotropin treatment. There was no significant difference in ovulation rate among the three groups (70.8% vs 58.6% vs 63.7%). However, the pregnancy rate was significantly higher in group 3 (18.2%, 4 cycles) compared to group 1 (8.3%, 2 cycles) and group 2 (6.9%, 2 cycles). Of pregnant cycles, all 2 cycles from group 1 were spontaneously aborted. One cycle in group 2 and one cycle in group 3 were spontaneously aborted and all other pregnant cycles were normally delivered.
CONCLUSION
With the combination therapy of metformin, the improvement in pregnancy rate among CC-resistant PCOS infertile women might be expected.

Keyword

Polycystic ovary syndrome; Clomiphene citrate-resistance metformin; Ovulation; Pregnancy

MeSH Terms

Anovulation
Body Weight
Clomiphene
Female
Gonadotropins
Humans
Hysterosalpingography
Infertility
Menstrual Cycle
Metformin*
Ovulation
Polycystic Ovary Syndrome*
Pregnancy
Pregnancy Rate
Semen Analysis
Spouses
Clomiphene
Gonadotropins
Metformin