Metformin—Comparison with Other Therapies in Ovulation Induction in Polycystic Ovary Syndrome
Abstract
Polycystic ovary syndrome (PCOS) is a common hormonal condition in women and is associated with insulin resistance, disorders of weight and metabolism, hyperandrogenism, anovulation, infertility, and menstrual irregularities. Its etiology is uncertain, but current theories emphasize genetic and intrauterine origins coupled with environmental factors such as diet and altered lifestyle patterns. Effective treatment of PCOS remains controversial but needs to be divided into the main requirements of the patient, depending on whether they are seeking cosmetic improvement, restoration of menstrual function, fertility, weight loss, or amelioration of metabolic changes. In recent years, so-called insulin-sensitizing agents such as metformin have found wide usage in PCOS based on the relationship between hyperinsulinism and ovarian hyperandrogenism. The introduction of these agents has led to questioning of established therapeutic pathways for ovulation induction, which have been based on clomiphene citrate and gonadotropins such as FSH. Much has been written about the value of laparoscopic ovarian drilling whereby diathermy or application of laser surgery to the ovary leads to enhanced ovulation, reduction in testosterone, and increased live birth rates. Although the procedure is less damaging to the ovary than wedge resection, concern has been expressed that adhesions may form that convert anovulatory infertility into tubal obstruction. Nevertheless, there is widespread use of this…
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