title: Assessment of ovarian stromal blood flow after metformin treatment in women with polycystic ovary syndrome.
abstract: OBJECTIVE
  To authenticate the effect of metformin treatment on ovarian stromal blood flow in women with polycystic ovary syndrome (PCOS) using 3-dimensional (3D) power Doppler.
  
  
  METHODS
  The current case-control study was conducted at Ain Shams University Maternity Hospital. A total of 60 women diagnosed to have PCOS were included as group 1. Another 40 fertile women who were recruited from outpatient clinic for contraception without PCOS with regular menstrual cycles were included as control group (group 2). All women underwent 3D power Doppler evaluations of ovarian stroma. Anthropometric, hormonal and biochemical criteria were also measured. All women in group 1 received metformin hydrochloride 500 mg tablets, which were started in a step-up maneuver every 5 days, from one to three tablets per day. The same parameters were also measured after the 3 months duration of treatment.
  
  
  RESULTS
  A total of 100 women were finally analyzed. At the start of the study, there were no statistically significant differences between group 1 and group 2 and regarding age and body mass index, but the waist/hip ratio and Ferriman-Gallwey scoring were statistically different between the 2 groups. The mean ovarian volume and stromal volume were significantly larger in group 1. 3D power Doppler indices [the vascularization index (VI), the flow index (FI) and the (VFI) vascularization-flow index] were much higher in group 1 than in group 2 (1.38 ± 0.76 vs. 4.69 ± 1.37, P < 0.05, 26.59 ± 2.26 vs. 32.66 ± 4.37, P < 0.05, and 0.76 ± 0.39 vs. 1.54 ± 0.69, P < 0.05, respectively). After 3 months of using metformin in normal weight PCO women, there was a statistically significant improvement in group 1 regarding, hirsutism, most of hormonal measurements. Also 3 months metformin treatment significantly reduce VI, FI and VFI (4.69 ± 1.37 vs. 2.95 ± 1.52, P < 0.05, 32.66 ± 4.37 vs. 29.48 ± 4.98, P < 0.05 and 1.54 ± 0.69 vs. 1.21 ± 0.7 P < 0.05, respectively). Using Receiver operator characteristic, there was no cut-off value of VI, FI or VFI to detect ovulation in women of PCOS.
  
  
  CONCLUSIONS
  Metformin seems to have a beneficial effect in normal weight PCO women via correcting ovarian stromal blood flow and hormonal profiles.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Abbasia, Cairo, Egypt, drahmedmakled@live.com.
authors.forename: Ahmed K
authors.initials: AK
authors.lastname: Makled
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Sherbiny
authors.forename: Rania
authors.initials: R
authors.lastname: Elkabarity
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D021621:Imaging, Three-Dimensional; D008687:Metformin / Q000627:therapeutic use*; D009765:Obesity / Q000503:physiopathology; D010053:Ovary / Q000098:blood supply* / Q000000981:diagnostic imaging; D010060:Ovulation; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D012372:ROC Curve; D018608:Ultrasonography, Doppler
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin