Pregnancy rate following Metformin consumption in patients with PCOS under ART treatment

Infertility with an incidence of about 15% has mainly been one of the community burdens that have even been threatening to the continuity of the family life. One of the most prevalent causes of women infertility is ovarian causes particularly PCOS. Since Metformin may improve quality and increase the number of ova, and likewise increase fertilization rate via reducing the level of insulin, this study was conducted with aim of investigating responses of patients with PCOS in the cycle of ART. This was a randomized clinical trial on 100 infertile patients with PCOS who referred to Shariati Hospital in Tehran during 1999-2000. The subjects were randomly categorized in to 2 groups [A=44 and B=46 women]. Ten patients were eliminated from study due to ignoring the treatment plan. Group A received Metformin at a dose of 500 mg t.i.d in addition to induction of ovulation with long protocol. The results were analyzed using t-test and X2 and P<0.05 was considered as significant. Results showed that average level of estradiol in group A was 2159_1056pg/ml and 2842 +/- 1050 pg/ml in group B, with a significant difference [P=0.002]. We administered 23 +/- 7.6 ampules of HMG for the subject's in group A and 31.34 +/- 8.12 ampules for those in group B [P = 0.001]. The difference in number of oocytes was not significant, where as we found a significant difference in the number of germinal vesicle [P = 0.047]. There were no significant differences in course of treatment, numbers of oocytes and the number of pregnancy between 2 groups. Considering the findings of this study by using Metformin, we improve the quality of ova in patients with PCOS. This happens due to the effect of Metformin through reducing insulin resistance and hyperandrogenism in patients with PCOS leading to a prominent drop in estradiol levels in serum that in turn lowers the need for administration of HMG and result in improving oocyte quality

[Inhibiting effects of metformin on ovarian hyperstimulation syndrome [OHSS] in induction of ovulation with gonadotropin in ART cycles on women with polycystic ovary syndrome [PCOS]]

In this research, it is supposed that treatment with Metformin prior to ovulation induction with gonadotropins in ART cycles, would be able to prevent OHSS and its severity among women with PCOS. This study was a randomized clinical trial on 100 women with PCOS who were treated in ART cycles. These women were divided randomly in two groups A and B [50 subjects each]. Group A received 500 mg of Metformin daily for about one month before induction ovulation with HMG and continued this treatment for about 45 days. Induction of ovulation protocol [classic long protocol] were similar in both groups. At the end of study the following results were compared in both groups : The serum Estradiol [E2] level on day of HCG administration and HMG doses [daily and total] were significantly lower in group A [P<0.002 and P<0.001 respectively]. The number of women with OHSS and its severity and the number of admission in group A were lower than group B [P<0.001 and P<0.02, respectively], but the numbers of oocyte, pregnancy and the duration of treatment with HMG were similar in both groups. These results show that Metformin by reducing resistance to insulin and hyperandrogenism, leads to reduction in E2 level and favors orderly follicular growth in response to exogenous gonadotropin and it reduces the risk and severity of OHSS

[Evaluation of ectopic pregnancy after assisted reproductive technology in infertility center of Shariati Hospital]

Ectopic pregnancy [EP] is a serious complication of pregnancy. Incidence of EP after normal pregnancy is%1 overall, but after assisted reproductive technology [ART] increases to%5. Many factors including: previous EP, tubal surgery, tubal pathology, previous infection of female genital tract, infertility and ART are identified as risk factors for EP. In this study 47 EP were studied over 4 years in infertility treatment center of Shariati Hospital which control group was chosen from uncomplicated pregnancies after ART. Two groups were matched in age, duration of infertility, mode of treatment. Incidence of secondary infertility and tubal factor were significantly higher in EP group. Incidence of previous EP, pelvic surgery, tubal pathology, manipulation of uterus and fibroma was significantly higher in EP group. Uterine embryo transfer was introduced as a risk factor for EP. Meticulous evaluation of risk factors need prospective studies