Pregnancy outcome in clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS) patients treated with and without metformin.

Abstract

Objective: To determine whether metformin treatment during ovulation induction alters pregnancy outcome in CC-resistant PCOS patients. Design: Retrospective case control study of PCOS patients treated in the reproductive endocrinology division at a major university program between 1998–2001. Materials/Methods: PCOS patients who previously failed to ovulate after CC dose ≥150 mg for 5 days and then conceived after use of metformin (500 mg TID) during ovulation induction were identified from our pregnancy database. Metformin was discontinued with a positive pregnancy test. Controls consisted of PCOS patients who conceived after requiring ≥150 mg CC for 5 days. PCOS definition required evidence of oligoovulation, hyperandrogenemia and normal thyroid, prolactin and 17-hydroxy progesterone levels. Information was obtained from the patient’s charts as well as via a follow-up telephone interview. The course and outcome of pregnancy was compared between the two groups using Fisher exact or Student’s t test where appropriate. Results: A total of 13 PCOS patients who previously failed to ovulate after CC dose ≥150 mg for 5 days and then conceived after use of metformin (Group A) were compared to 10 PCOS patients who conceived on CC >150 mg for 5 days (Group B). There was no statistical difference in the BMI between the two groups (p = 0.73) Pregnancy outcome was evaluated and no significant difference between groups was noted. Specifically, the incidence of pregnancy loss (A = 23%, B = 0%), multiple gestations, (A = 7.7%, B = 10%) and pre-term labor was not different between groups. Pregnancy complications such as gestational diabetes (A = 15%, B = 10%) and hypertension (A = 23%, B = 50%) were similar between the groups (p value = 0.235, 0.17 respectively.) No difference was seen in the incidence of induction of labor or cesarean section (p = 1.0). Conclusions: Concomitant metformin use in CC-resistant patients does not appear to significantly alter pregnancy outcome.