Summary: Metformin use in IVF patients

Survey observations are based on 101 IVF centers. The results relate to 50,800 IVF cycles, of which 5,260 include metformin, thus representing 10.4%


General comment

The majority (75%) reported that the data available in the literature is insufficient to reach a decision concerning efficacy of the treatment.

Indications for treatment based on the survey

Obesity with anovulation was the most common indication reported for treatment.
Poor-responder patients and habitual abortion also serve as indications for Metformin use.
Glucose is measured by 66% of the reporting centers before initiating Metformin.
Those who measure insulin consider high insulin as an indication for Metformin.
Glucose insulin ratio was not measured in most cases. However, those who observed this ratio accepted that less than 4.5 is suggestive of insulin resistance

When to start treatment and the preferable dose

The majority reported that they start Metformin between 1 and 3 months prior to initiating treatment. Most of the reporting centers use a dose between 1500 and 2000 mg/day.

Follow-up of treatment

The majority do not follow-up treatment with any specific blood test

How long should treatment continue?

Should the patient not conceive, no limit of treatment duration is reported.The majority continue treatment into the pregnancy period. It is interesting that 48% received treatment until the 12th gestational week and 12% continued treatment until delivery.

How does treatment influence outcome?

Most of the reported centers believe that treatment with Metformin:
Does not influence gondaotropin treatment
Increases pregnancy rate
Reduces rate of abortion