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Human Reproduction, Vol. 17, No. 9, 2230-2236, September 2002
© 2002 European Society of Human Reproduction and Embryology

Debates continued

Should patients with polycystic ovarian syndrome be treated with metformin?

Emre Seli and Antoni J. Duleba1

Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8063, USA

The recognition of insulin resistance as a principal factor in the pathogenesis of polycystic ovarian syndrome (PCOS) has led to the use of insulin-lowering agents, also called `insulin-sensitizing drugs', for its treatment. The most extensively studied insulin-lowering agent in the treatment of PCOS is metformin: an oral antihyperglycaemic agent used initially in the treatment of type 2 diabetes mellitus. Metformin is effective in the treatment of PCOS-related anovulation and infertility. Moreover, preliminary evidence indicates that metformin may also be effective in decreasing the risk of early spontaneous miscarriage in women with PCOS. Metformin also appears to induce cardioprotective effects on serum lipids as well as plasminogen activator inhibitor (PAI)-1 and may decrease the risk of development of type 2 diabetes. The highly promising therapeutic profile of metformin is related to the role of this agent in controlling an important aetiologic factor in the pathogenesis of PCOS: hyperinsulinaemia.

Key words: hyperinsulinaemia/metformin/polycystic ovarian syndrome

1 To whom correspondence should be addressed. E-mail: antoni.duleba{at}yale.edu


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