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Hum. Reprod. Advance Access originally published online on January 31, 2006
Human Reproduction 2006 21(6):1387-1399; doi:10.1093/humrep/dei501
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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

Michael F. Costello1,2,3,4, Michael Chapman1,3 and Una Conway1,3

1 Division of Obstetrics and Gynaecology, School of Women’s and Children’s Health, University of New South Wales, 2 Department of Reproductive Medicine, Royal Hospital for Women and 3 IVFAustralia, Sydney, NSW, Australia

4 To whom correspondence should be addressed at: Division of Obstetrics and Gynaecology, School of Women’s and Children’s Health, Level 1 Women’s Health Institute, Royal Hospital for Women, Locked Bag 2000, Randwick, Sydney, NSW 2031, Australia. E-mail: mfcostello{at}unsw.edu.au

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.

Key words: FSH/gonadotrophins/IVF/metformin/ovulation induction/polycystic ovary syndrome


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Home page
 Hum Reprod UpdateHome page
E. Moll, F. van der Veen, and M. van Wely
The role of metformin in polycystic ovary syndrome: a systematic review
Hum. Reprod. Update, November 1, 2007; 13(6): 527 - 537.
[Abstract] [Full Text] [PDF]


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