As an IVF expert, I am always looking for methods to improve the chance for pregnancy
for my patients. For many years, I have recommended using the medication metformin
for women with PCOS or insulin resistance in order to increase the chance for ovulation.
Some doctors have recommended using metformin to improve IVF success. Does it work? Let’s find out
Metformin is a medication used commonly by fertility specialists. Metformin works
by reducing the body’s resistance to insulin. Insulin resistance is the reason that some women,
such as women with PCOS, don’t ovulate. Reducing insulin resistance with metformin
will result in some women being able to ovulate and become pregnant
without the use of fertility medications. You can learn more about that here.
IVF does not rely on ovulation. Although fertility medications are used, the eggs are removed
from the ovary before ovulation, so why would metformin help? Really, I think that its unclear
why it would. Some doctors have pointed to the fact that some hormones, such as testosterone
are lowered and that this might help. One small study found better quality embryos. Really though,
there is no solid scientific reasoning why metformin would improve IVF.
There are many small studies on this topic. Some have found a benefit to
the use of metformin and some have not. If you are a subscriber to InfertilityTV
you know that when this happens, the best thing to do is to combine
all of the data from the smaller studies and analyze it together. The larger number of
study subjects helps us to form more definite conclusions. This is known as a meta analysis.
In 2014, a meta analysis combined the data from nine studies involving a total of 816 women with
PCOS. About half of the women received metformin and the other half either took no medication or
used a placebo of fake medication. This analysis found that the live birth rate
was the same in PCOS patients whether they took metformin or not. A few months ago,
this meta analysis was updated. There were now 13 studies involving over 1100 women.
In this analysis, they also found no increase in the live birth rate. With the added numbers
they were also able to break down the IVF cycles into different medication protocols
and look at the miscarriage rate. Bottom line is that there was no benefit to metformin.
Last year, a different group of researchers also did their
own meta analysis but they also failed to show any improvement in the chance for a live birth.
Our InfertilityTV bottom Line is this: Using metformin does not appear to increase
the success rate for women with PCOS who are doing IVF. I do want to point out one thing,
however. Using fertility medications for IVF can sometimes result in a complication called ovarian
hyperstimulation syndrome or OHSS. Women with PCOS tend to be very sensitive to fertility medications
and therefore have a higher risk for developing OHSS. Although metformin did not result in
more babies being delivered, all three meta analyses found that the risk of OHSS in PCOS
patients was lower in those who took metformin compared to those who did not take it. In fact,
there were less than half as many cases of OHSS in women who took metformin. On the other hand,
metformin can cause women to have gastrointestinal side effects,
so if your doctor thinks your risk for OHSS is low, there is probably no reason to take metofrmin
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