Abstract
OBJECTIVE: Metformin use in patients with polycystic ovary syndrome (PCOS) undergoing IVF is common. However, the effects of metformin in non-PCOS patients undergoing IVF have not been studied. Insulin, together with FSH, reduces fertilization and inhibits early cleavage and embryo differentiation in mice. Metformin, through modulation of ovarian steroidogenesis, can negate these deleterious effects. We evaluated the impact of metformin on embryo competency and pregnancy rates of ovulatory, non-PCOS patients undergoing IVF. DESIGN: Retrospective. MATERIALS AND METHODS: One hundred twenty-six ovulatory, non-PCOS patients (34.9±3.9 yrs) undergoing repeat IVF were analyzed. Pregnancy rates (PR) were compared between control (no metformin) and study (metformin) cycles. Secondary outcomes analyzed included # of oocytes retrieved and # of embryos available for transfer and/or cryopreservation. Outcomes were analyzed using McNemar's and paired t-tests. RESULTS: A statistically significant improvement in PR occurred in study cycles. Improved secondary outcomes occurred in study cycles including # of oocytes retrieved (12.8±7.1 vs 14.4±8.0, p<0.05) and # of embryos available for transfer and/or cryopreservation (3.1±1.8 vs 3.8±2.6, p<0.001).Table 1Control PRMetformin PROverall (n=126)20%50%p<0.001Protocol constant (n=66)aProtocol same in both cycles.21%52%p<0.001Age<35 (n=59)19%63%p<0.001Age≥35 (n=67)21%48%p<0.001BMI≤25 kg/m (n=98)24%60%p<0.001BMI>25 kg/m (n=26)8%42%p<0.05a Protocol same in both cycles. Open table in a new tab CONCLUSIONS: PR significantly improved in IVF cycles of ovulatory patients using metformin. Improved PR may be due to metformin-enhanced oocyte/embryo quality, which is demonstrated by an increase in number of oocytes retrieved and embryos available for transfer and/or cryopreservation. Metformin use in non-PCOS patients undergoing IVF is a promising therapy and deserves further investigation in the form of a randomized controlled trial.
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