Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Bl
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Impact of Metformin on IVF Outcomes in Overweight and Obese Women With Polycystic Ovary Syndrome: A Randomized Double-Blind Controlled Trial
Reproductive Sciences 1-7 ª The Author(s) 2018 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1933719118765985 journals.sagepub.com/home/rsx
Osama S. Abdalmageed, MD1, Tarek A. Farghaly, MD1, Ahmed A. Abdelaleem, MD1, Ahmed E. Abdelmagied, MD1, Mohammed K. Ali, MD2, and Ahmed M. Abbas, MD2
Abstract Objectives: To evaluate the impact of metformin on in vitro fertilization (IVF) outcomes in overweight and obese women with polycystic ovary syndrome (PCOS). Methods: This was a randomized double-blind placebo-controlled study (ClinicalTrials.gov: NCT 02910817) carried out in a University IVF Center. The study included 102 overweight and obese women (body mass index [BMI] >24 kg/m2) with PCOS who underwent their first fresh autologous IVF-embryo transfer cycle and agreed to participate in the study. The study participants were randomized into 2 groups: metformin group received metformin (1000 mg per day) at the start of controlled ovarian stimulation (COH) until the day of the pregnancy check, and placebo group received placebo tablets in the same duration. The primary outcome measure was the total number of retrieved oocytes. Results: Both groups were homogenous in baseline demographic characteristics. Metformin group versus the placebo group demonstrated decrease in the mean number of the retrieved oocytes (9.06 + 4.23 vs 16.86 + 8.3, P < .01) and similar live birth rate (LBR; 25.5% vs 17.6%, P ¼ .34). The number of fertilized oocytes was lower in the metformin group (5.65 + 2.66 vs 9 + 4.55, P < .01). However, the fertilization rate was similar in both groups (62.3% vs 53.4%, P ¼ .10). There was no difference in the implantation rate (15.7% vs 11.8%, P ¼ .32), multiple pregnancy rate (13.4% vs 3.9%, P ¼ .08), or miscarriage rate (23.5% vs 35.7%, P ¼ .46). No cases of ovarian hyperstimulation syndrome (OHSS) were observed in both groups. Conclusion: 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. Keywords metformin, polycystic ovary syndrome, obesity, overweight, in vitro fertilization Synopsis Metformin use could decrease the number of retrieved oocytes in overweight and obese women with polycystic ovary syndrome undergoing IVF.
Introduction Polycystic ovary syndrome (PCOS) is the most frequent cause of anovulatory infertility in women of reproductive age, accounting for about 10% prevalence.1 The women with PCOS may have some metabolic and reproductive abnormalities including insulin resistance (IR) with hyperinsulinemia. 2 Patients are diagnosed to have PCOS, according to Rotterdam criteria, when 2 of the following are present: chronic oligoovulation or anovulation, clinical or biochemical hyperandrogenism, and ultrasound polycystic ovaries.3 The primary mechanism of infertility in PCOS is chronic anovulation, and in vitro fertilizat
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