Association of metformin and pregnancy in the polycystic ovary syndrome - A report of three cases

BACKGROUND: Infertility is a common manifestation of the polycystic ovary s yndrome (PCOS), a condition characterized by chronic anovulation, hyperinsu linemia and hyperandrogenism. Hyperinsulinemia leads to increased ovarian a ndrogen production, resulting in follicular atresia and anovulation. Metfor min, a medication that improves insulin sensitivity and decreases serum ins ulin levels, restores menstrual cyclicity and ovulatory function and may im prove fertility rates in women with PCOS. We present three consecutive case s from our clinic that support this premise. CASES: Three patients were seen in the reproductive endocrinology clinic wi th documented PCOS, long-standing infertility and clinically diagnosed insu lin resistance. The first patient had hyperandrogenic, insulin-resistant ac anthosis nigricans syndrome and had been resistant to multiple courses of c lomiphene citrate; the second exhibited hypertension, hyperlipidemia and gl ucose intolerance along with anovulation; and the third presented with poor ly controlled type 2 diabetes and a desire to conceive. Each patient receiv ed metformin, which led to restoration of menstrual cyclicity and conceptio n in all three cases. CONCLUSION: These three patients reflect the heterogeneous nature of PCOS, and treating their underlying insulin resistance with metformin resulted in pregnancy. These findings suggest that metformin may be a useful adjunct f or treatment of infertility in patients with PCOS.