Insulin-Sensitizing Drugs for the Treatment of Infertility in Polycystic Ovary Syndrome

Abstract

A review. Infertility in polycystic ovary syndrome (PCOS) is characterized by anovulation and early pregnancy loss. A key component of PCOS is the presence of insulin resistance and compensatory hyperinsulinemia, which has an important role in the pathogenesis of infertility. As a result, insulin-sensitizing agents such as metformin and thiazolinediones have been studied in women with PCOS with the goal of improving ovulation. Multiple studies have demonstrated the effectiveness of metformin in improving ovulatory rates as a single agent and in combination with clomiphene citrate. Pregnancy rates are also increased when metformin is added to clomiphene. In addn., metformin with FSH induction may minimize ovarian hyperstimulation, although studies are limited. Recent data suggests metformin improves the endometrial environment during the peri-implantation period, thereby decreasing the rate of early miscarriage. Rosiglitazone and pioglitazone monotherapy increase ovulatory rates, as well as the combination of clomiphene and rosiglitazone. Prelimary studies suggest that thiazolinediones may be more effective in obese women with PCOS compared with metformin in improving ovulation. However, with the thiazolinediones as category C pregnancy drugs, their use as fertility agents is less clear than metformin. [on SciFinder(R)]