Pregnancy outcome in infertile patients with polycystic ovary syndrome who were treated with metformin.
OBJECTIVE
To analyze pregnancy complications and outcome in patients with polycystic ovary syndrome (PCOS) treated with metformin.


METHODS
Single center retrospective case analysis.


METHODS
Private regional nonurban referral subspecialty practice.


METHODS
After 7 months of average metformin use, 188 patients with PCOS (average infertility: 27 months) achieved 237 pregnancies.


METHODS
Of pregnancies established, metformin alone was used before conception in 124/237 (52%), oral fertility agents (CC or letrozole) in 81 (34%), gonadotropin therapy in 7 (3.0%), assisted reproduction in 17 (7.2%), and other fertility-promoting regimens in 8 (3.4%).


METHODS
Analysis of prepregnancy health parameters (weight, blood pressure, glucose tolerance, fasting and stimulated insulin levels) and pregnancy outcomes (miscarriage, pregnancy length, hypertension, gestational diabetes, weight gain, birth weight, sex ratio, congenital malformations, and breastfeeding success).


RESULTS
Metformin appears to decrease the rate of spontaneous abortion. The co-morbidities of PCOS including obesity, insulin resistance, and glucose sensitivity served as indicators of increased risk for pregnancy complications, especially gestational diabetes. No increase in pregnancy-induced hypertension was evident. Prematurity was increased. Neither PCOS nor metformin use appears to increase the rate of congenital anomaly. PCOS did not affect lactation.


CONCLUSIONS
PCOS or its co-morbidities are associated with poorer pregnancy outcome. Implications and interventions are discussed.
Center for Applied Reproductive Science, Johnson City, Tennessee 37604-6088, USA. thatcher@ivf-et.com
Samuel S
SS
Thatcher
Elizabeth M
EM
Jackson
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007247:Infertility, Female / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies
D008687:Metformin