title: A systematic review and meta-analysis of randomized controlled trials on metformin co-administration during gonadotrophin ovulation induction or IVF in women with polycystic ovary syndrome.
abstract: BACKGROUND
  A systematic review of randomized controlled trials (RCTs) comparing whether metformin co-administration with gonadotrophins for ovulation induction (OI) with timed intercourse or IVF improves outcome in women with polycystic ovary syndrome (PCOS).
  
  
  METHODS
  The quality of reporting of meta-analyses (QUOROM) guidelines were followed. A systematic computerized literature search of three bibliographic databases was performed.
  
  
  RESULTS
  Eight RCTs were included in the overall review. Meta-analysis demonstrated that the co-administration of metformin to gonadotrophin OI does not significantly improve ovulation [odds ratio (OR) = 3.27; 95% confidence interval (95% CI) = 0.31-34.72] or pregnancy (OR = 3.46; 95% CI = 0.98-12.2) rates. Metformin co-administration to IVF treatment does not improve pregnancy (OR = 1.29; 95% CI = 0.84-1.98) or live birth (OR = 2.02, 95% CI = 0.98-4.14) rates but reduces the risk of ovarian hyperstimulation syndrome (OHSS) (OR = 0.21; 95% CI = 0.11-0.41, P < 0.00001).
  
  
  CONCLUSIONS
  Current data on the use of metformin in the gonadotrophin OI or IVF treatment settings are inconclusive because of the review's failure to exclude an important clinical treatment effect. Further RCTs are necessary to definitively clarify whether metformin co-administration during gonadotrophin OI or IVF will improve the efficacy of these treatments in PCOS women.
authors.affiliation: Division of Obstetrics and Gynaecology, School of Women's and Children's Health, University of New South Wales, Sydney, Australia. mfcostello@unsw.edu.au
authors.forename: Michael F
authors.initials: MF
authors.lastname: Costello
authors.forename: Michael
authors.initials: M
authors.lastname: Chapman
authors.forename: Una
authors.initials: U
authors.lastname: Conway
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006062:Gonadotropins / Q000378:metabolism*; D006801:Humans; D008687:Metformin / Q000008:administration & dosage*; D016017:Odds Ratio; D010062:Ovulation Induction; D010919:Placebos; D011085:Polycystic Ovary Syndrome / Q000150:complications* / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D006062:Gonadotropins; D010919:Placebos; D008687:Metformin