Does metformin affect ovarian morphology in patients with polycystic ovary syndrome? A retrospective cross-sectional preliminary analysis

Angela Falbo,Stefano Palomba,Achille Tolino,Erika Rania,Francesco Orio,Fulvio Zullo,Roberta Venturella,Caterina Materazzo

doi:10.1186/1757-2215-2-5

Abstract

BackgroundThe significance of polycystic ovarian morphology and its relation to polycystic ovary syndrome (PCOS) is unclear, but probably it is associated with higher androgen and insulin levels and lower sex hormone binding globulin (SHBG) in absence of identifiable differences in gonadotropin dynamics. The aim of this study was to evaluate ovarian morphology in patients affected by PCOS with different ovulatory responses to metformin.MethodsIn this cross-sectional analysis, we studied 20 young normal-weight PCOS patients who had received a six-month course of metformin treatment. Ten of these patients remained anovulatory (anovulatory group), whereas other ten became ovulatory, but failed to conceive (ovulatory group). Other ten age- and body mass index (BMI)-matched PCOS subjects were also enrolled as controls and observed without any treatment (control group).ResultsAfter six months of metformin, in both PCOS treated groups, a similar improvement in testosterone (T) and insulin resistance indexes was observed. Moreover, in one (10.0%) and nine (90.0%) subjects from anovulatory and ovulatory PCOS groups, respectively, ovarian morphology changed, whereas a significant reduction in ovarian dimension was observed in the PCOS ovulatory group only.ConclusionPCOS patients under metformin administration demonstrate a change in ovarian morphology closely related to ovulatory response.

Highlights

The significance of polycystic ovarian morphology and its relation to polycystic ovary syndrome (PCOS) is unclear, but probably it is associated with higher androgen and insulin levels and lower sex hormone binding globulin (SHBG) in absence of identifiable differences in gonadotropin dynamics
Polycystic ovary syndrome (PCOS) was firstly defined by the presence of oligo/amenorrhea and hyperandrogenism in association with polycystic ovary (PCO) morphology seen at the time of surgery [1] and, thereafter, observed by ultrasound [2]
Our previous data suggested a specific effect of metformin on ovaries, showing that PCOS patients ovulating under treatment had an improved ovarian artery blood flow, and a better dominant follicle and corpus luteum vascularization [17]

Summary

Introduction

The significance of polycystic ovarian morphology and its relation to polycystic ovary syndrome (PCOS) is unclear, but probably it is associated with higher androgen and insulin levels and lower sex hormone binding globulin (SHBG) in absence of identifiable differences in gonadotropin dynamics. Few reports from the previous studies [7,10,11,12,13] suggested that this finding is often associated to abnormal gonadotropin levels, lower levels of insulin growth factorbinding protein-1 (IGF-BP1), increased insulin resistance and increased ovarian 17-hydroxiprogesterone (17-OHP) and androgen responses to gonadotropins-releasing hormone (GnRH)-agonists. Our previous data suggested a specific effect of metformin on ovaries, showing that PCOS patients ovulating under treatment had an improved ovarian artery blood flow, and a better dominant follicle and corpus luteum vascularization [17]

Objectives

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Results