Association of Metformin With Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome Undergoing In Vitro Fertilization: A Systematic Review and Meta-analysis

Yiqing Wu, Mixue Tu, Yun Huang, Yifeng Liu, Dan Zhang, Yiqing Wu, Mixue Tu, Yun Huang, Yifeng Liu, Dan Zhang

Abstract

Importance: Metformin is widely used among women with polycystic ovary syndrome (PCOS). However, its associations with outcomes of in vitro fertilization or intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) in women with PCOS remain controversial.

Objective: To assess whether metformin is associated with improved outcomes of IVF/ICSI-ET in women with PCOS.

Data sources: PubMed, Embase, and Cochrane were searched from database inception to January 31, 2020.

Study selection: Only randomized clinical trials (RCTs) were included. Eligible studies enrolled women with PCOS undergoing infertility treatment with IVF/ICSI-ET and reported at least 1 outcome of IVF/ICSI-ET.

Data extraction and synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta analyses guidelines. Two authors independently extracted the data. Study quality was evaluated using the GRADE system. Treatment effect was quantified using odds ratios (ORs) with 95% CIs using random-effect models with the Mantel-Haenszel method.

Main outcomes and measures: Ovarian hyperstimulation syndrome (OHSS), clinical pregnancy rate, and live birth rate.

Results: A total of 12 RCTs, which collectively included 1123 women with PCOS undergoing infertility treatment with IVF/ICSI-ET, were identified. The risk of OHSS in women randomized to metformin was lower than in women not randomized to metformin (OR, 0.43; 95% CI, 0.24-0.78), although this difference was not significant for women with PCOS with a body mass index of less than 26 (OR, 0.67; 95% CI, 0.30-1.51). There was no significant difference in clinical pregnancy rate (OR, 1.24; 95% CI, 0.82-1.86) or live birth rate (OR, 1.23; 95% CI, 0.74-2.04) in the total population studied. However, in a post hoc analysis among women with a body mass index of 26 or greater, metformin treatment was associated with increased clinical pregnancy rates (OR, 1.71; 95% CI, 1.12-2.60).

Conclusions and relevance: In this study, metformin treatment was associated with a decreased risk of OHSS but had no association with the overall clinical pregnancy rate or live birth rate among women with PCOS undergoing IVF/ICSI-ET. Metformin treatment should be carefully considered for women with PCOS undergoing IVF/ICSI-ET and may be more preferred for women with a body mass index greater than 26.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. Flow Diagram of Study Selection
Figure 1.. Flow Diagram of Study Selection
Figure 2.. Risk of Bias Graph
Figure 2.. Risk of Bias Graph
B, Green plus signs indicate low risk of bias; gray question marks, unclear risk of bias; and orange minus signs, high risk of bias.
Figure 3.. Association of Metformin With Ovarian…
Figure 3.. Association of Metformin With Ovarian Hyperstimulation Syndrome (OHSS) Rate
BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); OR, odds ratio.
Figure 4.. Association of Metformin With Clinical…
Figure 4.. Association of Metformin With Clinical Pregnancy and Live Birth Rates
BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); OR, odds ratio.

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