The patient undergoing fertility treatments is likely to encounter many confusing statistics and studies related to their particular course of treatment. One of the most common faced at fertility treatment centers may be whether or not Metformin improves IVF outcomes.
According to Balen and Michelmore, 2002, polycystic ovary syndrome (PCOS) is the most common endocrine disorder encountered at fertility treatment centers and accounts for 80% of anovulatory infertility. Between 5-7% of reproductive age women are affected. While IVF treatment is an effective treatment for many patients, women with PCOS respond differently than women with normal ovaries, which adds to the difficulty in understanding the data.
PCOS
To understand the findings, and the divergent opinions about the results, you must first understand some about PCOS. The disorder, which gets its name from the small cysts found on the ovaries of patients with the disorder, is marked by prolonged menstrual periods, access hair growth and weight gain. Patients with the disorder are also likely to be at risk of heart disease and type 2 diabetes.
Recent Studies
Recent studies have discovered that Metformin, an insulin sensitizing agent, can improve outcomes in women who are commonly resistant to Clomiphene Citrate and also insulin resistant. The 2009 study published in the Journal of Obstetrics and Gynecology reports that Metformin notably decreases the incidence of miscarriage, as well as ovarian hyper stimulation syndrome (OHSS), while positively affecting the oocyte and embryo quality in Clomiphene Citrate resistant PCOS women undergoing IVF. New and continuing studies continue to shed light on the positive role Metformin can play in PCOS patients.
About Metformin
In spite of detractors, the evidence gained from three of the most recent studies is extremely positive. The random, double blind, controlled trials and several cohort studies indicate that when taken with Clomiphene Citrate, Metformin can be successful in enhancing the probability of ovulation and pregnancy. The study also supports findings that Metformin improves Clomiphene resistant anovulation in women treated with follicle-stimulating hormone. The use of Metformin shows drastic reduction in the rate of cycle cancellation and ovarian hyper stimulation syndrome when compared to gonadotropins alone. One study shows that patients undergoing IVF and being treated with FSH and Metformin had a noticeable increase in the number of mature oocytes retrieved, fertilization rates, as well as the number of embryos produced.
Metformin and Weigh Loss
Since PCOS can often result in significant weight gain, fertility treatment centers treating women with PCOS with the drug Metformin will also commonly encourage weight loss in these patients. Taking Metformin will also commonly result in weight loss. Some suggest that the resulting weight loss is responsible for the more favorable outcomes.
Clinical Consequences
It is important for women with PCOS receive treatment since it has been linked to increased risk of developing cardiovascular disease and Type 2 Diabetes. Fertility treatment centers find that by the age of 40, nearly 40% of PCOS patients develop impaired glucose tolerance or clinical diabetes. While in the reproductive years, PCOS patients are more likely to experience spontaneous abortions and develop gestational diabetes. Those who develop gestational diabetes are at increased risk of developing hyperandrogenism and hyperinsulinemia later in life. Patients diagnosed with PCOS should address all of their concerns with the fertility treatment center's staff.
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