PCOS and metformin use

When I last met with Hannam, he recommended no Metformin or Glumetza, contrary to my previous RE's strongly-worded recommendation to stay on it (even when I complained at how lethargic it made me feel). Hannam said that new research is showing that Met should be prescribed only when glucose intolerance is an issue, and it's not for me (yet, anyway - I have a strong family history of diabetes, but I seem to be fine so far).

Here is the abstract (and the full-text article is located for free here: http://humrep.oxfordjournals.org/cgi/content/full/23/3/462):

Human Reproduction 2008 23(3):462-477; doi:10.1093/humrep/dem426

© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org


Consensus on infertility treatment related to polycystic ovary syndrome
The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group*
March 2–3, 2007, Thessaloniki, Greece

The treatment of infertile women with polycystic ovary syndrome (PCOS) is surrounded by many controversies. This paper describes, on the basis of the currently available evidence, the consensus reached by a group of experts regarding the therapeutic challenges raised in these women. Before any intervention is initiated, preconceptional counselling should be provided emphasizing the importance of life style, especially weight reduction and exercise in overweight women, smoking and alcohol consumption. The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC). Recommended second-line intervention, should CC fail to result in pregnancy, is either exogenous gonadotrophins or laparoscopic ovarian surgery (LOS). The use of exogenous gonadotrophins is associated with increased chances for multiple pregnancy and, therefore, intense monitoring of ovarian response is required. LOS alone is usually effective in <50% of women and additional ovulation induction medication is required under those circumstances. Overall, ovulation induction (representing the CC, gonadotrophin paradigm) is reported to be highly effective with a cumulative singleton live birth rate of 72%. Recommended third-line treatment is in vitro fertilization. More patient-tailored approaches should be developed for ovulation induction based on initial screening characteristics of women with PCOS. Such approaches may result in deviation from the above mentioned first-, second- or third-line ovulation strategies in well-defined subsets of patients. Metformin use in PCOS should be restricted to women with glucose intolerance. Based on recent data available in the literature, the routine use of this drug in ovulation induction is not recommended. Insufficient evidence is currently available to recommend the clinical use of aromatase inhibitors for routine ovulation induction. Even singleton pregnancies in PCOS are associated with increased health risk for both the mother and the fetus.


Key words: polycystic ovary syndrome/infertility treatment/2007 consensus



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This symposium was supported by an unconditional grant from NV Organon and by ESHRE and ASRM.
This consensus document is being published simultaneously in Human Reproduction and Fertility and Sterility.

Reprint requests: Basil C. Tarlatzis, Unit for Human Reproduction, First Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki 54603, Greece. E-mail: tarlatzis@hol.gr

* Group members: B. C. Tarlatzis (Gr), B. C. J. M. Fauser (NL), R. S. Legro (USA), R. J. Norman (Aus), K. Hoeger (USA), R. Pasquali (It), S. Franks (UK), I. E. Messinis (Gr), R. F. Casper (Can), R. Homburg (Is), R. Lobo (USA), R. W. Rebar (USA), R. Fleming (UK), B. R. Carr (USA), Ph. Bouchard (Fr), J. Chang (USA), J. N. Hugues (Fr), R. Azziz (USA), E. M. Kolibianakis (Gr), G. Griesinger (Ger), K. Diedrich (G), A. Balen (UK), C. Farquhar (NZ), P. Devroey (B), P. C. Ho (HK), J. Collins (Can), D. G. Goulis (Gr), R. Eijkemans (NL), P. G. Crosignani (It), A. DeCherney (USA), A. Van Steirteghem (B).

Submitted on September 3, 2007; accepted on December 14, 2007.