- Tahereh Nazari
 - - Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science, Babol, Iran
- Mahmoud Haji Ahmadi
- - Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science, Babol, Iran
- Mahtab Zeinalzadeh
- - Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science, Babol, Iran
- Sedigheh Esmaeilzadeh
- - Department of Social Medicine, Faculty of Medicine, Babol University of Medical Science & Health Services, Babol, Iran
- Maryam Gholizadeh
- - Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science, Babol, Iran
- Mehrangiz Baleggi
- - Babol University of Medical Sciences, Babol, Iran
Received: 4/1/2003 Accepted: 4/1/2003 - Publisher : Avicenna Research Institute |
| Related Articles |
|
| Other Format |
|
|
|
Abstract
Polycystic ovary syndrome (PCO) is the most common problem among ovarian dysfunctions that accompany infertility and ovulation problem. The prevalence of ovulation dysfunction is reported as high as 40% in general population. The first step in management of PCO is weight reduction and then drug therapy. Clomiphen citrate is the first choice for ovulation induction. Considering the resistance of some patients to this drug, other methods have been also employed. This study evaluated whether metformin had beneficial effect in clomiphen resistant patients with polycystic ovarian syndrome in an infertility clinic or not. Thirty-four patients resistant to clomiphene were randomly divided in to 2 groups. One group was treated with metformin plus HMG (group A) and the other with HMG alone (group B). Hormonal assessment and GTT were performed before administration of 1500 g of metformin (500mg three times daily). HMG was injected the next month. The response was assessed by the restoration of follicle growth (16-18mm) and pregnancy rate. The findings were analyzed by T-test and Chi-Square. In the first group, we had 2.4±1.9 adequate follicle response in each patient. In the second group we had 1.3±1.4 adequate follicle responses. For the first group the number of HMG was 6.2±1.4 while for the second group it was 6.1±1. In the first group (P=0.17) the stimulation length was 10.5±1.4 days (P=0.77), and in the second group, it was 10±1.4 days. There was no significant difference in length of stimulation and total HMG received among the two groups. For the first group, the pregnancy rate was 29.4% and in the second groups, the rate appeared to be 11.8% (P=0.199), the difference was not statistically significant. In the first group, there were four patients with hyperinsulinemia, all of them had follicle growth. But in the second group, there were five patients with hyperinsulinemia but only one of them had follicle response. Metformin is not always beneficial when given to clomiphene-resistant infertile women with PCO in clinical practice. We recommend that the use of metformin in PCO patients with hyperinsulinemia.
Keywords:
Ovulation induction, Polycystic ovary, Metformin, Human menopausal genadotropin To cite this article:References
- Speroff L., Glass R.H., Kase N.G. Clinical Gynecology Endocrinology and Infertility. 6th Edition, Lippincott Williams & Wilkins. 1999;PP:487-513.
- Ryan K.J., Berkwits R.S., Barbieri R.L., DunaifA. Kistners Gynecology & Womens Health. 7th Edition, A Times Miror Co. 1999;PP:443-462.
- Berek J.S., Adashi E.Y., Hillard P.A. Novaks Gynecology. 13th Edition, Baltimore Williams & Wilkins. 2002; PP:876.
- Martens J.W., Geller D.H., Arlt W. Enzimatic activties of P450c 17 stably expressed in fibroblasts form patients with the polycystic ovary syndrome. J Clin Endocrinol Metab. 2000;85(11): 4338-46.
- Luboureau S., Barbosa S., Rodin P., Rohmer V. Polycistic ovary syndrome. Fertil Steril. 1999;72(72):282-5.
- Velazques E.M., Mendoza S.T., Sosa F., Glueck C.J. Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia and systolic blood pressure, while facilitating normal menses and pregnancy. Metabol Clin Exp. 1994;(43):647-654.
- Dunaif A., Scott D., Finegood D., Quintana B., Whitcomb R. The insulin sensitising agent troglitazone improves metabolic and reproductive abnormalities in the polycystic ovarian syndrome. J Clin Endocrinol Metab. 1996;81: 3299-3306.
- Rossing M.A., Daling J.R., Weiss N.S., Moore D.E., Self S.G. Ovarian tumours in a cohort of infertile women. N Engl J Med. 1994;331:771-776.
- Lobo R.A., Gysler M., March C.M., Goebelsmann U., Mishel D.R. Clinical and laboratory predictors of clomiphene response. Fertil Steril. 1982;37:168-174.
- Roy M.B., HomBurc B.S. Polycysticovary syndrome. Martin Dunitz LTD. 2001;P:12.
- Sturrock N.D., Lannon B., Fay T.N. Metformin dose not enhance ovulation induction in clomiphene resistant polycystic ovary syndrome in clinical practice. Br J Clin Pharmacol. 2002;53(5): 469-73.
- Nestler J.E., Jakubowicz D.J., Evans W.S., Pasquali R. Effects of metformin on spontaneous and clomiphene-induced ovulation in the polycystic ovary syndrome. Diabetologia. 1998;338:1876-1880.
- DeLoe V., La Marca A., Ditto A., Morgante G., Cianic A. Effect polycystic ovary syndrome. Fetil Steril. 1999;72(72): 282-5.
- Vandermolen D.T., Ratts V.S., Evans W.S. Metformin increases the ovulatory rate and pregnancy rate from clomiphene citrat alone. Fertil Stril. 2001;75(2):310-5.
- زينالزاده مهتاب، آلياسين اشرف، آقاحسيني مرضيه. موفقيت حاملگي بدنبال مصرف متفورمين در بيماران با سندرم تخمدان پليكيستيك تحت درمان با ART. مجله باروري و ناباروري. 1381، سال سوم، شماره 10، 24-19.
- Seale F.G., Robinson R.D., Neal G.S. Association of metformin and pregnancy in the polycistic ovary syndrome a report of the three cases. J Repred Med. 2000;45(6):507-10.
- Yarali H., Yildyz B.O., Demirol A. Co-administration of metformin during FSH treatment in patients with clomiphenecitrate-resistant PCOS. Hum Reprod. 2002;17(9):2481-2.