Clinical outcome of various metformin treatments for women with polycystic ovary syndrome

AIM: Polycystic ovary syndrome (PCOS) is an ovulatory disorder and insulin resistance and diabetes are involved in its pathophysiology. Metformin, an anti‐diabetic agent, has been reported to be useful to induce ovulation. METHODS: Metformin treatment was classified into four types: (1) clomiphene–metformin combination treatment for clomiphene‐resistant patients; (2) clomiphene–metformin combination for clomiphene‐sensitive patients; (3) clomiphene–metformin combination for naïve patients; and (4) metformin monotherapy. The patients underwent physical, endocrinological, and clinical examinations for their ovulation rates, pregnancy rates, and follicular development. RESULTS: The ovulation rates, pregnancy rates, and single follicular development were not significantly different among the clomiphene–metformin combination treatment groups. In the Body Mass Index (BMI) subanalysis, the pregnancy rate was higher in the BMI≥30 kg/m(2) group than in the other three groups with a BMI of ≤30 kg/m(2) in both cycles and cases. The ovulation rates and pregnancy rates were significantly higher in the group with a fasting insulin of ≥15 μU/mL than in the groups with a fasting insulin of <15 μU/mL in both cycles and cases. CONCLUSION: Clomiphene–metformin combination treatment appears to be useful, at least for clomiphene‐resistant patients, and a BMI of >30 kg/m(2) and a fasting insulin of ≥15 μU/mL appear to be predictors of a good result with this treatment.