Outcome of clinical pregnancies after ovulation induction using metformin

Abstract

The objective of this study was to review the first 50 clinical pregnancies of women with polycystic ovarian syndrome (PCOS) who had ovulation induced either with metformin alone, or in combination with clomifene. The study was confined to women with PCOS attending our infertility service. A register of clinical pregnancies was maintained of women who conceived after metformin therapy. The metformin was continued throughout the first trimester. The outcome of pregnancy was determined by individual chart review. Of the 50 women, 21 conceived with a combination of clomifene and metformin, and 29 with metformin alone. Seven women had a first trimester loss and 43 had a live birth. There were no perinatal deaths, no neonatal seizures and no congenital malformations. There were also no multiple pregnancies. The overall caesarean rate was 37%, and none of the babies had an Apgar score less than 7, at 5 min. This study found no evidence of any adverse clinical effects when metformin is continued in the first trimester of women with PCOS following ovulation induction. There was also no evidence of an increase in the rate of miscarriage or multiple pregnancy.

Metformin reduces abortion in pregnant women with polycystic ovary syndrome

“…plasma endothelin-1, soluble intercellular adhesion molecule, soluble vascular adhesion molecule and E-selectin [36][37][38][39]). But safety always comes first and in a recent study Turner and associates [40] found there was no evidence of any adverse clinical effects when metformin is continued in the first trimester following ovulation induction in PCOS women. There was also no evidence of an increase in the rate of miscarriage or multiple pregnancies.…”

Continuation of metformin in the first trimester of women with polycystic ovarian syndrome is not associated with increased perinatal morbidity

“…This is gradually increased over a three-week period from 500 mg once a day to 500 mg three times a day to reduce gastrointestinal side effects [16]. If the woman does not conceive after four months of metformin treatment, clomifene citrate (Clomid) is added at 50 mg daily orally from day 2-6 of the menstrual cycle.…”

Use of metformin during pregnancy for women with polycystic ovary syndrome

“…Of the 25 trials included for this review, there were four randomised controlled trials (RCTs) [10][11][12][13], one clinical trial [14], four retrospective cohort studies [15][16][17][18], and sixteen prospective cohort studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. These studies were conducted globally with a large number originating from USA.…”

“…These studies were conducted globally with a large number originating from USA. Metformin was limited to the first trimester in four trials [11,14,16,27], with the remainder continuing metformin for the entire duration of pregnancy. A comparison of continuing metformin in the first trimester and throughout pregnancy was made in four trials [10,23,26,33].…”

“…Of the remaining three studies, two showed no difference in miscarriage rates with the use of metformin compared to normal populations [11,27], and the remaining RCT showed that continuing metformin throughout pregnancy results in the same miscarriage outcomes as ceasing metformin after eight weeks [10].…”