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This study aimed to assess the safety and effectiveness of Metformin, anti-obesity drugs, and Inositol in women with polycystic ovary syndrome (PCOS) undergoing in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Despite potential benefits in reducing the risk of cystic enlargement of the ovaries associated with in-vitro fertilization, Metformin and Myoinositol do not notably improve pregnancy outcomes in women with PCOS.
This study aimed to assess the safety and effectiveness of Metformin, anti-obesity drugs, and Inositol in women with polycystic ovary syndrome (PCOS) undergoing in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
English-language studies up to Oct 26, 2024, were searched across PubMed, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov. The inclusion criteria focused on randomized trials evaluating the effects of Metformin, anti-obesity agents, and Inositol.
The frequentist approach was used to perform the network meta-analysis. Subgroup analyses were performed considering the controlled ovarian stimulation protocols and body mass index (BMI). For all treatment comparisons, summary odds ratios (ORs) or standardized mean differences (SMDs) accompanied by 95% confidence intervals (CIs) were computed.
A total of 20 RCTs involving 1827 patients and 6 different treatments were included. Nineteen trials were classified as low risk, while one was considered moderate risk. The pairwise meta-analysis showed that Metformin did not improve pregnancy rates but decreased ovarian hyperstimulation syndrome risk, particularly in GnRH agonist protocols. It also resulted in lower estradiol (E2) levels on the trigger day and increased adverse effects (Table 1):
Compared to the controls, the network meta-analysis revealed no substantial disparities in pregnancy outcomes for these treatments. Myoinositol was associated with a shorter gonadotropin duration and fewer side effects compared to controls (Table 2):
Also, Metformin was linked to lower E2 levels (SMD = -376.52, 95% CI -610.83 to -142.22), a higher number of mature oocytes (SMD = 2.23, 95% CI 0.36–4.10) and increased adverse effects. There was no indication of an elevated risk for congenital anomalies (birth defects).
Metformin and Myoinositol may decrease the risk of OHSS in PCOS but don't particularly improve pregnancy outcomes. More randomized trials are required to verify these results.
Journal of Ovarian Reserve
Comparative efficacy and safety of Metformin, anti-obesity agents, and MyoInositol in improving IVF/ICSI outcomes and reducing ovarian hyperstimulation syndrome in women with polycystic ovary syndrome: a systematic review and network meta-analysis
Lijun Lin et al.
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