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Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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)

CONCLUSION:

  • 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

Learn More – Primary Sources:

Association of Metformin With Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis

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Related ObG Topics:

PCOS: Targeting Treatments to Improve Reproductive Outcomes and Reduce CVD
Polycystic Ovary Syndrome: Making the Diagnosis
AHRQ Report: Comparative Effectiveness and Safety of Treatments for Common Causes of Infertility
Results from the PregMet2 Trial: Does Metformin Treatment for PCOS Decrease Risk of Late Miscarriage and Preterm Birth?
EUROmediCAT Data: Does Metformin Use in the First Trimester of Pregnancy Increase the Risk for Congenital Anomalies?

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