Effects of metformin combined with clomiphene on endothelial function, endocrine indicators and clinical outcomes in infertile women with polycystic ovary syndrome

Abstract

Objective To investigate the effects of metformin combined with clomiphene on endocrine index, vascular endothelial function, pregnancy rate and ovulation rate in infertile women with polycystic ovary syndrome(PCOS). Methods From January 2018 to January 2019, 60 cases of PCOS with infertility treated in Zhuji People's Hospital were studied.According to the random number table, they were divided into control group and study group, with 30 cases in each group.The control group was treated with clomiphene, while the study group was treated with metformin and clomiphene.The levels of endocrine indicators including follicle stimulating hormone (FSH), luteinizing hormone (LH), pituitary prolactin (PRL), testosterone (T) and estradiol (E2) were compared between the two groups before and after treatment.The levels of fasting insulin (FIN), fasting plasma glucose (FPG) and insulin resistance index (HOM-IR) were compared between the two groups before and after treatment.The pregnancy rate, ovulation rate and abortion rate were observed and compared between the two groups after treatment. Results In the comparison of endocrine indicators, the levels of LH, PRL, T, E2, FIN and FPG in the control group[(8.84±1.13)IU/L, (18.57±2.13)μg/L, (2.75±0.54)nmol/L, (62.49±5.73)ng/L, (16.55±7.84)IU/mL, (5.16±0.74)mmol/L] were improved after treatment compared with before treatment[(16.32±1.26)IU/L, (20.48±3.29)μg/L, (3.88±0.64)nmol/L, (59.13±4.95)ng/L, (21.33±5.32)IU/mL, (5.67±0.81)mmol/L; t=24.207, 2.669, 7.391, 2.431, 2.763, 2.546, P=0.000, 0.005, 0.000, 0.009, 0.004, 0.007], while the levels of FSH and HOM-IR were not significantly improved after treatment[(5.32±1.53)IU/L, (3.19±1.41)] compared with before treatment[(5.44±1.69)IU/L, (3.64±2.15); t=0.288, 0.959, P=0.387, 0.171]. The levels of LH, PRL, T, E2, FIN, FPG and HOM-IR in the study group[(6.25±1.47)IU/L, (16.24±2.16)μg/L, (3.79±0.83)nmol/L, (68.82±4.67)ng/L, (12.69±6.24)IU/mL, (4.63±0.71)mmol/L, (2.55±1.43)] were significantly improved after treatment compared with before treatment (t=24.576, 5.437, 9.277, 6.779, 5.479, 5.621, 2.018, P=0.000, 0.000, 0.000, 0.000, 0.000, 0.000, 0.020), and the decrease of FSH was not significant after treatment[(5.17±1.55)IU/L, (5.21±1.54)IU/L]. After treatment, the levels of LH, PRL, T, FIN, FPG and HOM-IR in the study group decreased significantly, while the level of E2 increased significantly compared with those in the control group[(6.25±1.47)IU/L, (16.24±2.16)ug/L; t=7.651, 4.207, P=0.000, 0.000]. After treatment, CIMT in both two groups[(0.075±0.018)mm, (0.067±0.016)mm]was lower than before treatment[(0.088±0.028)mm, (0.088±0.022)mm], and the improvement in the study group was better than the control group(t=1.819, P=0.037). The body mass index (BMI) and endometrial thickness of the two groups were decreased after treatment[(24.53±3.11)kg/m2, (23.15±3.17)kg/m2, (9.46±0.72)mm, (8.89±0.67)mm] compared with before treatment[(26.91±4.02)kg/m2, (27.03±3.85)kg/m2, (12.03±0.45)mm, (11.92±0.53)mm], and the improvement degree of the study group was significantly better than that of the control group(t=1.702, 3.174, P=0.047, 0.001). As to clinical outcomes, the ovulation rate and pregnancy rate of the study group (50.00%, 76.67%) were higher than those of the control group (20.00%, 50.00%)(χ2=5.034, χ2=4.593, all P 0.05). Conclusion Metformin combined with clomiphene can effectively improve the level of endocrine indicators, regulate insulin resistance, improve BMI, reduce endometrial thickness, correct hyperandrogenic status, effectively promote ovulation, improve pregnancy rate and achieve obvious therapeutic effect in PCOS patients with infertility. Key words: Metformin; Clomiphene; Polycystic ovary syndrome; Infertility; Endocrine; Endothelial function; Pregnancy rate; Ovulation rate; Endometrial thickness