Grand Rounds

Is Metformin Associated with Better IVF Outcomes in Women with PCOS and Higher BMI?

BACKGROUND AND PURPOSE:

Wu et al. (JAMA Netw Open, 2020) looked at whether metformin is associated with improved IVF/ICSI-ET outcomes in women with PCOS when factoring in BMI

Systematic review and meta-analysis
Data sources
- PubMed, Embase, and Cochrane (Inception to January 31, 2020)
Inclusion criteria
- RCTs
- Studies that enrolled women with PCOS undergoing infertility treatment with IVF/ICSI-ET
Study design
- Two authors independently extracted the data
- Study quality was evaluated using the GRADE criteria
- Exclusion criteria included women with a history of diabetes or other endocrinological disease
The authors quantified treatment effect using odds ratio (OR) with 95% CIs using random-effect models
Primary outcomes
- Ovarian hyperstimulation syndrome (OHSS)
- Clinical pregnancy rate
- Live birth rate

12 RCTs | 1,123 women
- Overall, metformin was associated with lower risk of OHSS
- OR 0.43 (95% CI, 0.24 to 0.78)
Women in metformin group had lower odds of OHSS if BMI ≥26
- BMI <26: OR 0.67 (95% CI, 0.30-1.51; 4 RCTs; 425 participants; P=0.34)
- BMI ≥26: OR 0.25 (95% CI, 0.12-0.51; 6 RCTs; 482 participants; P<0.001)
In the total population, there was no significant difference in
- Clinical pregnancy rate
  - OR 1.24 (95% CI, 0.82 to 1.86)
- Live birth rate
  - OR 1.23 (95% CI, 0.74 to 2.04)
In women with BMI ≥26, metformin was associated with increased clinical pregnancy rates (P=0.01) but not live birth rates (P=0.07)

Metformin use by women with PCOS was not associated with increased clinical pregnancy or live birth rates among women undergoing IVF/ICSI-ET
The authors did find that in women with BMI ≥26, OHSS was less frequent and clinical pregnancy rates were higher but there was no difference with respect to live birth rates

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