Routine Use of Metformin for Ovulation Induction in PCOS is No Longer Recommended

KatCarney · 03-01-2008, 10:57 PM

Hum Reprod. 2008 Mar

Consensus on infertility treatment related to polycystic ovary syndrome.

The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group.
Thessaloniki 54603, Greece.

The treatment of infertile women with polycystic ovary syndrome (PCOS) is surrounded by many controversies. This paper describes, on the basis of the currently available evidence, the consensus reached by a group of experts regarding the therapeutic challenges raised in these women.

Before any intervention is initiated, preconceptional counselling should be provided emphasizing the importance of life style, especially weight reduction and exercise in overweight women, smoking and alcohol consumption.

The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC).

Recommended second-line intervention, should CC fail to result in pregnancy, is either exogenous gonadotrophins or laparoscopic ovarian surgery (LOS). The use of exogenous gonadotrophins is associated with increased chances for multiple pregnancy and, therefore, intense monitoring of ovarian response is required. LOS alone is usually effective in <50% of women and additional ovulation induction medication is required under those circumstances. Overall, ovulation induction (representing the CC, gonadotrophin paradigm) is reported to be highly effective with a cumulative singleton live birth rate of 72%.

Recommended third-line treatment is in vitro fertilization.

More patient-tailored approaches should be developed for ovulation induction based on initial screening characteristics of women with PCOS. Such approaches may result in deviation from the above mentioned first-, second- or third-line ovulation strategies in well-defined subsets of patients.

Metformin use in PCOS should be restricted to women with glucose intolerance. Based on recent data available in the literature, the routine use of this drug in ovulation induction is not recommended. Insufficient evidence is currently available to recommend the clinical use of aromatase inhibitors for routine ovulation induction. Even singleton pregnancies in PCOS are associated with increased health risk for both the mother and the fetus.

Eva37 · 03-02-2008, 07:25 AM

thanks for sharing

Stacie M · 03-02-2008, 09:10 AM

Hmmmm, interesting. I believe that when researchers finally find out the cause of PCOS, they will find that insulin resistance is the culprit. Whether lab tests show you in the normal range, I still believe it is the underlying issue. So many people with PCOS (but no lab evidence of IR) have good results. Of course, I'm no expert...

KatCarney · 03-02-2008, 10:44 AM

Quote:

Originally Posted by Stacie M

So many people with PCOS (but no lab evidence of IR) have good results. Of course, I'm no expert...

Keep in mind that this article isn't simply about 'treating pcos'...it's specifically addressing the course of treatment that should be followed when a pcos'er is trying to get pregnant and needs ovulation induction.

MyDuckySam · 03-02-2008, 11:57 AM

Kat, this is very interesting.

Thank you. I have my first follow-up March 13 to review my first month of Met and 10 days of Provera. I'm going to take a list of questions to my ob.

ilovebailey · 03-02-2008, 09:12 PM

I think it is very easy for them to say that extremely expensive, often self-pay methods like injectables and IVF should come before met, which is minimally invasive and covered by insurance. There is research out there in favor of their point, but also research that shows met works for ttc. To write it off and not include it as one of the first options just doesn't make sense, but I guess they've got to make a living too...

KatCarney · 03-02-2008, 09:19 PM

Quote:

Originally Posted by ilovebailey

I think it is very easy for them to say that extremely expensive, often self-pay methods like injectables and IVF should come before met, which is minimally invasive and covered by insurance. There is research out there in favor of their point, but also research that shows met works for ttc. To write it off and not include it as one of the first options just doesn't make sense, but I guess they've got to make a living too...

The didn't 'write met off'. They simply looked at the available research and drew conclusions based on that research.

For women who want to fast track their conception, it's valuable information.

Some people want to know what works BEST, not simply what's the 'cheapest' option.

Plus, their true 'first line' suggestion is FREE:

Quote:

Before any intervention is initiated, preconceptional counselling should be provided emphasizing the importance of life style, especially weight reduction and exercise in overweight women, smoking and alcohol consumption.

How many of us 'write off' ^those^ things?

Stacie M · 03-03-2008, 09:31 AM

Quote:

Originally Posted by KatCarney

Keep in mind that this article isn't simply about 'treating pcos'...it's specifically addressing the course of treatment that should be followed when a pcos'er is trying to get pregnant and needs ovulation induction.

Ahhh, thanks for catching that. I was looking at it from the PCOS standpoint alone, not just TTC. That is a good point too. When I took met the first time, I did have reduction in PCOS symptoms, felt better, etc. but didn't have ovulation still. So obviously, it may work well to help my PCOS but may not necessarily be the best fertility drug for me.

KatCarney · 03-03-2008, 06:51 PM

Quote:

Originally Posted by KatCarney

The didn't 'write met off'. They simply looked at the available research and drew conclusions based on that research.

more on this...

Clomiphene alone and NOT in combination with Metformin as first-line help for PCOS

Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome

Metformin Mania - should all cysters take Metformin?

EXCERPT FROM ONE OF THE ARTICLES:

Quote:

This is the largest, most comprehensive effort yet to compare the two drugs in helping PCOS patients achieve successful pregnancy. The findings appear in the New England Journal of Medicine.

"With this study, my colleagues and I recommend and support the use of clomiphene alone and NOT in combination with Metformin as a first-line therapy for infertility in women with PCOS," said Christos Coutifaris, MD, PhD, Director of the Division of Reproductive Endocrinology and Infertility and the principal investigator from Penn. "These results emphasize the need to test any new application rigorously, no matter how promising it may seem initially."

According to the study authors, women who took metformin ovulated more that the women who were given the standard treatment. Similarly, women in the combination therapy group ovulated more frequently than did the women in either the clomiphene-alone or the metformin-alone groups. However, as the current study revealed, an increase in ovulation did not result in more successful pregnancies and deliveries for either the metformin alone, or combination group.

"The bottom line here is that ovulation does not necessarily result in a successful pregnancy," said Coutifaris "The results suggest that an ovulation due to clomiphene is two times as likely to result in pregnancy compared to an ovulation caused by metformin."

kellie105 · 03-03-2008, 07:01 PM

Both times that i have gotten pregnant have been from Met only, even though I tried the other recommendations (clomid, had a lap scheduled then got BFP). I NEVER ovulated till Met and my insulin levels have always come back as normal.

KatCarney · 03-03-2008, 07:14 PM

Just to avoid any confusion...

The studies aren't suggesting that metformin isn't helpful in achieving pregnancy...

The studies are simply saying that after looking at the stats and studies, women who took CLOMID ONLY had MORE 'successful' full term pregnancies.

This is not to say that there won't be women who are successful on met alone.

But for women who want to know which therapy that has the 'best odds' the information is worthwhile.

kellie105 · 03-05-2008, 02:54 PM

Oh O.K. I misunderstood...i feel so dense here lately - LOL