Avaliação do uso da metformina no resultado ovulatório de pacientes portadoras da síndrome de ovários policísticos resistente ao uso isolado do citrato de clomifeno

Abstract

Objective: To evaluate the effect of metformin associated to clomiphene citrate (CC) on ovulation, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). Design: prospective, randomized, doubleblind, placebo-controlled study. Material and methods: A total of 67 patients with PCOS who received 2 cycles of clomiphene citrate (100 mg/day from days 5 to 9) were initially included in the study. Patients who did not respond to clomiphene citrate were randomly allocated to receive either metformin 850 mg twice daily(group 1) or placebo twice daily (group 2) taken for two months in a row. After that associated to CC (100 mg/day from days 5 to 9) for the two following cycles. Insulin,glucose,glucose/insulin ratio, testosterone, sulfate dehydroepiandrosterone, follicle stimulating hormone (FSH), luteinising hormone (LH), thyroid-stimulating hormone (TSH), prolactin, creatinin, glutamate oxalacetate transaminase and glutamate pyrovate transaminase, were evaluated before the beginning and the end of this study. Also,it was measured body mass index (BMI), endometrialthickness, ovulation, and pregnancy rates. Results: A total of 36 patients were resistant to clomiphene citrate. In the metformin group, 15/21 (71,4%) women ovulated, and 8/21 (38,1%) conceived. In the control group, 5/15 (33,3%) women ovulated and 3/15 (20%) conceived. Compared with the control group, the metformin group had significantly higher ovulation (p=0,04), however, there was no significant difference in the pregnancy rate between the two groups. When patients were separated according to BMI, we observed that obese patients (>28)had higher ovulation rates in the metformin group (11/12) than placebo group (2/8) (p=0,004). However this result was not observed for patients with BMI <28 (4/9 and 3/7 for metformin and placebo, respectively). Conclusion: Metformin associated to CC improves ovulation and pregnancy rates in clomiphene citrateresistant women with polycystic ovary syndrome, specially in obese patients.