Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): A multicenter, double-blind, placebo-controlled randomized trial

Abstract

Background: The role of metformin in the treatment of infertility in women with polycystic ovary syndrome (PCOS) is still controversial. Objective and Outcomes: We investigated whether metformin decreases the early miscarriage rate and improves the pregnancy rates (PR) and live-birth rates (LBR) in PCOS. Methods: This was a multicenter, randomized (1:1), double-blind, placebo-controlled study. Three hundred twenty women with PCOS and anovulatory infertility were randomized to metformin (n = 160, Diformin; obese women, 1000 mg two times daily; nonobese subjects, 500 mg + 1000 mg daily) or identical doses of placebo (n = 160). After 3 months'treatment, another appropriate infertility treatment was combined if necessary. If pregnancy occurred, metformin/placebo was continued up to the 12th week. Results: Miscarriage rates were low and similar in the two groups (metformin 15.2% vs. placebo 17.9%,P= 0.8). Intent-to-treat analysis showed that metformin significantly improved PR and LBR (vs. placebo) in the whole study population (PR:53.6 vs. 40.4%, P = 0.006; LBR:41.9 vs. 28.8%, P = 0.014) and PR in obese women (49.0 vs. 31.4%,P= 0.04), and there was a similar trend in nonobese (PR:58.6 vs. 47.6%, P = 0.09; LBR:46.7 vs. 34.5%, P = 0.09) and in obese women with regard to LBR (35.7 vs. 21.9%, P = 0.07). Cox regression analysis showed that metformin plus standard infertility treatment increased the chance of pregnancy 1.6 times (hazard rate 1.6, 95% confidence interval 1.13-2.27). Conclusion: Obese women especially seem to benefit from 3 months' pretreatment with metformin and its combination thereafter with routine ovulation induction in anovulatory infertility. Copyright © 2012 by The Endocrine Society.