title: Metformin use in patients undergoing in vitro fertilization treatment: results of a worldwide web-based survey.
abstract: OBJECTIVE
  To identify trends regarding therapeutic approaches to metformin administration in patients undergoing in vitro fertilization (IVF) treatment worldwide.
  
  
  METHODS
  A retrospective evaluation utilizing the results of a web-based survey, IVFWorldwide ( www.IVF-worldwide.com/ ), was performed.
  
  
  RESULTS
  Responses from 101 centers performing a total of 50,800 annual IVF cycles was performed. Of these cycles, 10.4% (n = 5,260) reported metformin use during IVF cycles. Indications for metformin use in IVF cycles included polycystic ovary syndrome (PCOS) patients who were habitual abortions (67%), had prior poor egg quality (61%), had high serum insulin levels (56%). Less reported was PCOS with obesity/anvoulation (29%), PCOS with multiple manifestations (23%) and glucose intolerance and insulin resistance (23%). Over half of cycles (54%) treated patients with metformin up to 3 months prior to starting IVF. A majority (82%) of IVF cycles utilized 1500-2000 mg/day of metformin. A nearly equal percentage of centers continued metformin up to a positive β-HCG test (35%) or to 12 weeks gestation (33%). 70% of IVF cycles reported increased pregnancy rates and decreased miscarriage rates due to the use of metformin. 75% reported the data in the literature is not sufficient for reaching a definitive conclusion concerning metformin treatment in patients undergoing IVF.
  
  
  CONCLUSIONS
  While metformin is used worldwide as an adjunct to standard IVF protocols, there is much variation in its use and the majority of centers report lack of evidence supporting its use.
authors: Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, mchris21@jhmi.edu.
authors: Mindy S
authors: MS
authors: Christianson
authors: Harold
authors: H
authors: Wu
authors: Yulian
authors: Y
authors: Zhao
authors: Matan
authors: M
authors: Yemini
authors: Milton
authors: M
authors: Leong
authors: Zeev
authors: Z
authors: Shoham
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced; D005260:Female; D005307:Fertilization in Vitro / Q000187:drug effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007333:Insulin Resistance; D020407:Internet; D008687:Metformin / Q000009:adverse effects / Q000627:therapeutic use*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D011247:Pregnancy; D018873:Pregnancy Rate; D011795:Surveys and Questionnaires
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
references: Gynecol Endocrinol. 2006 May;22(5):235-8
references: 16785142
references: Cochrane Database Syst Rev. 2014;11:CD006105
references: 25406011
references: Hum Reprod Update. 2007 Nov-Dec;13(6):527-37
references: 17767003
references: Hum Reprod. 2008 Mar;23(3):462-77
references: 18308833
references: Obstet Gynecol. 2008 Apr;111(4):959-68
references: 18378757
references: Clin Endocrinol (Oxf). 2009 Feb;70(2):311-21
references: 18691273
references: Acta Obstet Gynecol Scand. 2009;88(5):563-8
references: 19306135
references: Fertil Steril. 2001 Mar;75(3):505-9
references: 11239532
references: Obstet Gynecol. 2003 Apr;101(4):785-93
references: 12681887
references: Gynecol Endocrinol. 2003 Jun;17(3):207-14
references: 12857428
references: Ceska Gynekol. 2003 May;68(3):155-62
references: 12879653
references: Hum Reprod. 2004 Jun;19(6):1315-22
references: 15117902
references: Fertil Steril. 2005 Sep;84(3):798-801
references: 16169430
references: Hum Reprod. 2006 Jun;21(6):1416-25
references: 16501038
references: J Obstet Gynaecol. 2009 Oct;29(7):651-5
references: 19757275
references: Cochrane Database Syst Rev. 2010;(1):CD003053
references: 20091537
references: Hum Reprod. 2011 Aug;26(8):2045-53
references: 21606131
references: Fertil Steril. 2011 Nov;96(5):1128-33
references: 21917254
references: Fertil Steril. 2011 Dec;96(6):1384-1390.e4
references: 21982727
references: BJOG. 2013 Feb;120(3):267-76
references: 23194199
references: Hum Reprod Update. 2014 Nov-Dec;20(6):853-68
references: 25013215
references: Fertil Steril. 2007 Jun;87(6):1487-90
references: 17254579