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

KatCarney · 03-01-2008, 09:57 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.

*suzie* · 03-01-2008, 11:19 PM

Thanks for the info Kat. I take metformin and I don't have any glucose problems. I have had this discussion with RE about if I need the metformin or not and she said that I should take it. I guess I will have to have another chat with her. It seems as though many cysters that don't have IR take metformin. Sometimes it is so hard to know who to belive. Right now I have to believe what my RE says because I need to have trust in her that she is going to help me get pregnent.

Sarah01 · 03-02-2008, 12:30 AM

I don't have glucose issues either and have been on Met for a couple of years now. My cycles are regular, and my hair doesn't fall out while on it. I wonder if there is any reasoning behind this recommendation?

lj2blessed · 03-18-2008, 10:54 AM

This is interesting...my gyn prescribed me Met and I don't have IR. However, it has regulated my cycles...but I'll be sure to ask him at my appt next week.

zilla · 03-18-2008, 11:44 AM

I don't have glucose troubles either but I am afraid of clomid.

Chana_S · 03-18-2008, 01:23 PM

I don't understand this!
I am not IR. Before I found met I was O (getting AF at least) every 6 months. After taking met for 3 months my cycles were regular 5 week cycles!
I stopped taking met for a while and then started again when I got married. I was O, but not regularly. I doubled my met dose and fell PG that cycle. With my next 2 PG I fell PG because I doubled my met dose again.
T"G this was not my Dr's view, because I would hate to take artificial hormones when a non-hormonal method results in PG!