Is metformin a multifunctional medication for inducing ovulation and improving pregnancy outcomes in PCOS?

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Purpose:To review the pathophysiology of polycystic ovary syndrome (PCOS), discuss the use of metformin—an insulin-sensitizing agent—as an ovulation induction agent, and investigate whether use of metformin improves ovulation and pregnancy outcomes in females with PCOS.Data sources:Review of the published literature in on-line journals, CINAHL database, and MD Consult database using key search terms of metformin, ovulation-induction, anovulation, polycystic ovary syndrome, insulin resistance, and pregnancy.Conclusion:Evidence supports the use of metformin as an appropriate first-line therapy for ovulation induction of infertile PCOS females and also for the treatment of menstrual irregularity. Current data suggest that metformin taken during pregnancy may reduce miscarriage rate, gestational diabetes mellitus complications, and fetal growth problems.Implications for practice:Metformin, as a single agent, is useful for multiple purposes in the treatment of PCOS: decreasing intestinal glucose uptake and both basal and postprandial glucose levels; inducing ovulation; and improving pregnancy outcomes.

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