A comparative trial of metformin and oral contraceptive pretreatment in patients with polycystic ovary syndrome undergoing ICSI for severe male factor infertility.

Objective: The aim of our study was to evaluate the effect of metformin and oral contraceptive (OC) pretreatment in patients with polycystic ovaries (PCO) and high body mass index (BMI) undergoing assisted reproductive techniques. Design: Prospective randomized trial. Materials/Methods: A total of 102 cycles were evaluated, 35 cycles with metformin (group I) and 67 cycles with OC (group II) pretreatment. Female age, BMI, duration of induction, total gonadotropin ampules used, estradiol levels on hCG day, number or total and metaphase-II oocytes and injected oocytes, fertilization rate, number of transferred embryos and pregnancy rates were compared in between the groups. Furthermore BMI, 17hydroxyprogesterone (17OH-P), dihydroepiandrosterone sulphate (DHEAS), free testosterone (f-T), androstenedione, luteinizing hormone (LH), fasting insulin and blood glucose, renal and hepatic function tests were evaluated before and after metformin therapy. Results: A higher dose of gonadotropins were needed in metformin group than OC group (p < 0.05) and also a higher pregnancy rate was achieved in metformin group (p < 0.05). No statistically significant difference was found between the other parameters. BMI, 17OH-P, DHEAS, f-T, LH, fasting insulin and SGPT values were found to be significantly different in group I before and after metformin therapy (p < 0.01). Furthermore less ovarian hyperstimulation syndrome and higher ongoing pregnancy rates were achieved in metformin group than OC pretreatment group. The comparison of laboratory and clinical results in both groups. legendlegendChi-square test.Metformin (n=35)OC (n=67)pAge (years)30.7 ± 3.929.2 ± 5.2NSDuration of induction (days)12.7 ± 1.212.6 ± 1.5NSGonadotropin ampules32.8 ± 10.226.3 ± 11.1<0.05Peak estradiol (pg/ml)2265 ± 8632400 ± 884NSTotal oocytes retrieved17.4 ± 6.416.6 ± 7.8NSM-II oocytes14.5 ± 5.913.6 ± 5.8NSFertilized oocytes10.2 ± 4.49.3 ± 4.4NSBMI29.3 ± 5.928.0 ± 4.3NSPregnancy rate (%)71.451.5<0.05legend Chi-square test. Open table in a new tab Conclusions: It can be concluded that metformin may be a better alternative than OC pretreatment in patients with PCO and high BMI, undergoing ICSI treatment for male infertility.