ABSTRACT

Objective: to study the effect of insulin sensitizer Metformin on fertility, pregnancy complications and pregnancy outcome when given in adequate dose for adequate time period in insulin resistant polycystic ovary syndrome (PCOS) patients.
Methodology: this prospective observational analysis was conducted at Baqai Institute of Reproduction and Developmental Sciences (BIRDS), an In Vitro Fertilization (IVF) center of Pakistan in Baqai University Karachi from January 2010 to December 2012. All patients with insulin resistant PCOS presenting to BIRDS with infertility were included in the study. Detailed history regarding demographic details, duration of infertility and previous treatment of infertility were noted. Complete physical examination was done. Laboratory investigations included serum FSH, LH, testosterone, serum insulin levels, FBS and ultrasound of pelvis. Patients were given Metformin in adequate dose (1500-2500 mg/day) for at least 3-6 months and more if needed, those becoming pregnant were followed in their pregnancies till the final outcome. SPSS 12 was used to analyses the data.
Results: two hundred and seventy seven women with insulin resistance PCOS were given Metformin in adequate dose (1500-2500 mg/day) for at least 3 months. Out of these 277, 72 (26%) became pregnant, of which 59 (71%) had no maternal side effects and no birth defects. From the remaining13 patients, 10(14%) had missed abortions and 2 had intrauterine deaths in second and 1 in third trimester. These patients either received inadequate dose or conceived within 3 months and stopped taking Metformin in first trimester.
Conclusion: metformin in adequate dose and duration increases fertility and prevents pregnancy complications in both foetus and mother and improves pregnancy outcome.
Key Words: Insulin Resistance, PCOS, Metformin.