Higher-order multiple pregnancy associated with metformin in women with polycystic ovary syndrome: two cases and review of the literature.
OBJECTIVE
To describe the first reported cases of two women with polycystic ovary syndrome (PCOS) desirous of pregnancy who conceived trichorionic pregnancies following ovulation induction with metformin alone and metformin plus clomiphene.


METHODS
Case report.


METHODS
Private fertility practice.


METHODS
Two women with polycystic ovary syndrome, one lean and one overweight, both oligoovulatory and not undertaking their first cycle of treatment.


METHODS
Ovulation induction by metformin alone or in combination with clomiphene


METHODS
Higher-order multiple pregnancy (triplet or greater).


RESULTS
Two cases of trichorionic pregnancy.


CONCLUSIONS
This is the first report of higher-order multiple pregnancies resulting from the use of either metformin alone or in combination with clomiphene. The additive effects of adjunctive treatments such as weight reduction, ovarian drilling, and clomiphene and metformin therapy may result in an increased incidence of higher-order multiple pregnancy and women need to be counseled about this risk. Further research is required to quantify the risk of this event per treatment cycle.
Boothroyd
Clare
C
Greenslopes Specialist Centre, Brisbane, Queensland, Australia. feritility@optushome.com.au
Yazdani
Anusch
A
D000328:Adult; D002996:Clomiphene / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D008687:Metformin / Q000009:adverse effects*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications; D011272:Pregnancy, Multiple
D005300:Fertility Agents, Female; D007004:Hypoglycemic Agents; D002996:Clomiphene; D008687:Metformin