Intrauterine insemination outcome in polycystic ovary syndrome patients following metformin therapy

Abstract EN

Women with polycystic ovary syndrome (PCOS) are sensitive to stimulation with exogenous reproductive hormones.

They have a risk of developing ovarian hyperstimulation syndrome.

Women with PCOS are characterized with bilateral enlargement of ovaries.

These patients have disorder in the menstrual cycles and they are infertile.

The goal of the study was to assess the outcome of intrauterine insemination (IUI) in PCOS women treated with metformin prior to application IUI.

The PCOS patients (n = 180) were grouped to five age groups (group one : 20-25 yr, group two : 26-30 yr, group three: 31-35 yr, group four : 36-40, and group five : > 40 yr) while the control group (n = 96, mean age 32 yr) was infertile but without PCOS.

The PCOS patients were administered 500 mg metformin twice daily for three months prior to IUI.

Controlled ovarian stimulation (COS) was induced by clomiphene citrate, and human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG).

IUI was performed 30 to 36 hours following HCG injection.

The IUI patients received 400 mg progesterone for three months.

Testosterone concentration was higher and the endometrial thickness was lower in PCOS groups compared to control group (p < 0.05).

The number of follicles > 16 mm was significantly lower in PCOS groups versus control group (P < 0.05).

The estradiol concentration on cycle day 12 was significantly lower in PCOS patients compared to the control group (P < 0.01).

The pregnancy rate (PR) per cycle was 28 % in the PCOS group and 51 % in the control group (P < .0.005).

It was concluded from this study that the normal function of the ovary in PCOS women was adversely affected when the patient age was advanced especially at age group of > 36 years.

The 28 % PR indicates that PCOS women should undergo COS- IUI before their involvement in intensive and costly IVF or ICSI program.