Role of Metformin in Polycystic Ovary Syndrome (PCOS)-Related Infertility Original paper

What was reviewed?

This review explores the role of metformin in treating polycystic ovary syndrome (PCOS)-related infertility. PCOS is a common endocrinological disorder that can lead to infertility, characterized by insulin resistance, hyperandrogenism, and anovulation. The review discusses metformin’s mechanisms, its impact on insulin sensitivity, its role in improving ovulation, and its effectiveness in managing metabolic and hormonal imbalances in women with PCOS. The review also emphasizes the drug’s benefits in improving menstrual cyclicity and reducing hyperandrogenism, ultimately aiding in fertility restoration.

Who was reviewed?

The review synthesizes findings from various clinical studies and trials examining the effects of metformin on women with PCOS. It draws on observational studies and randomized controlled trials to evaluate the efficacy of metformin in addressing infertility associated with PCOS. The women studied in these trials typically had anovulatory infertility, hyperandrogenism, and varying degrees of insulin resistance, and they were treated with metformin to assess its impact on ovulation and fertility.

What were the most important findings?

The review found that metformin has significant therapeutic benefits for women with PCOS, particularly in restoring menstrual regularity and improving ovulation rates. Metformin works primarily by improving insulin sensitivity, which reduces hyperinsulinemia—a key factor in the pathogenesis of PCOS. This insulin-sensitizing effect contributes to lower circulating androgen levels, which is crucial in managing symptoms like hirsutism and acne. In several studies, metformin, either alone or in combination with other treatments like clomifene citrate, successfully induced ovulation in women who were resistant to standard treatments.

Furthermore, metformin appears to improve metabolic dysfunctions common in PCOS, including insulin resistance, dyslipidemia, and obesity, all of which contribute to the infertility and long-term health risks associated with the condition. However, the review also noted that while metformin improves metabolic and reproductive outcomes, its efficacy in women with significant obesity is less pronounced. The review also highlights that metformin is generally well-tolerated, although some women may experience gastrointestinal side effects.

What are the greatest implications of this review?

The review underscores metformin’s potential as a first-line treatment for women with PCOS-related infertility, especially for those who are insulin-resistant and non-obese. The findings suggest that metformin could be a safer and more accessible alternative to more invasive fertility treatments like in vitro fertilization (IVF). Moreover, metformin’s role in reducing the risk of ovarian hyperstimulation syndrome during assisted reproductive technology procedures makes it particularly valuable in IVF protocols. The review also emphasizes the need for further studies to determine the optimal dose and long-term benefits of metformin, particularly for women with more severe obesity or metabolic complications.