Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome.
OBJECTIVE
To evaluate whether pretreatment with metformin improves FSH-induced ovulation in women with clomiphene-resistant polycystic ovary syndrome (PCOS).


METHODS
Randomized prospective trial.


METHODS
Department of Obstetrics and Gynecology, University of Siena.


METHODS
Twenty women with clomiphene citrate-resistant PCOS.


METHODS
The women were divided randomly into groups A and B (10 subjects each). Group B received 1,500 mg of metformin for at least a month before a single cycle of FSH stimulation. Group A underwent two cycles of FSH stimulation and then received metformin for a month before undergoing a third cycle.


METHODS
The number of FSH ampules, days of treatment, E2 level on the day of hCG, number of follicles > 15 mm, number of hyperstimulation, and the number of cycles with hCG withheld.


RESULTS
The number of follicles > 15 mm in diameter on the day of hCG administration was significantly lower in cycles performed after metformin treatment. The percentage of cycles with hCG withheld because of excessive follicular development was significantly lower in cycles treated with metformin. Plasma levels of E2 were significantly higher in cycles treated with FSH alone than in those treated with FSH and metformin.


CONCLUSIONS
By reducing hyperinsulinism, metformin determines a reduction in intraovarian androgens. This leads to a reduction in E2 levels and favors orderly follicular growth in response to exogenous gonadotropins.
De Leo
V
V
Department of Obstetrics and Gynecology, University of Siena, Italy. deleo@unisi.it
la Marca
A
A
Ditto
A
A
Morgante
G
G
Cianci
A
A
D000328:Adult; D000735:Androstenedione / Q000097:blood; D002996:Clomiphene / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007986:Luteinizing Hormone / Q000097:blood; D008687:Metformin / Q000627:therapeutic use*; D010060:Ovulation / Q000187:drug effects*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000503:physiopathology*; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome
D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D002996:Clomiphene; D000735:Androstenedione; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D008687:Metformin