Metformin Treatment Before in Vitro Fertilization (IVF) in Women With Ultrasound Evidence of Polycystic Ovaries

Inclusion criteria

• Women attending with ovulatory PCO due to undergo IVF/ICSI treatment.
• First or second cycle of IVF/ICSI.
• If previously on metformin, a minimum one month washout period was required.
• Polycystic ovaries diagnosed by ultrasound presence of ≥12 follicles measuring 2-9 mm in diameter in at least one ovary and/or increased ovarian volume (≥10 ml).
• Written informed consent.

Exclusion criteria

• Clinical manifestations of PCOS, including any of the following:

• Oligo- or amenorrhoea with cycles ≥42 days apart.
• Anovulation with mid-luteal progesterone <16 nmol/L.
• Biochemical hyperandrogenism with serum testosterone ≥3.5 nmol/L and/or free androgen index >5 (FAI = [total testosterone/SHBG] x 100).
• Clinical hyperandrogenism with hirsutism or acne requiring treatment at least weekly.
• Age >38 years.
• BMI >35 kg/m2.
• Basal FSH >12 IU/L.
• Liver disease or ALT >80 IU/L.
• Renal disease, or creatinine >130 nmol/L.
• Alcoholism or drug abuse.
• Diabetes mellitus (evaluated by fasting glucose >6.7mmol/L).
• Per oral steroid treatment in last month.
• Cimetidine, anticoagulation, erythromycin, or other macrolides in last month.
• Hyperprolactinemia (Prolactin >700 mIU/L).
• Abnormal thyroid function tests (TSH outside of laboratory normal range).
• Congenital adrenal hyperplasia.