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Hum. Reprod. Advance Access published online on January 31, 2006
Human Reproduction, 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
Received November 9, 2005
Revised December 20, 2005
Accepted December 22, 2005

Article

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. Costello 1 *, Michael Chapman 2, and Una Conway 2

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

* To whom correspondence should be addressed.
Michael F. Costello, E-mail: mfcostello{at}unsw.edu.au


  Abstract

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.

Keywords: FSH/gonadotrophins/IVF/metformin/ovulation induction/polycystic ovary syndrome.
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