Update on the Therapeutic Role of Metformin in the Management of Polycystic Ovary Syndrome: Effects on Pathophysiologic Process and Fertility Outcomes

Metformin plays a significant role in managing polycystic ovary syndrome (PCOS) by improving insulin resistance, which helps resolve hormonal and metabolic issues, thereby increasing ovulation, pregnancy, and live birth rates compared to placebo. It is particularly effective when combined with clomifene citrate for women with clomifene-resistant PCOS, but not more effective than letrozole alone when combined with it. Continuing metformin through the 1st trimester may reduce miscarriage rates, and it is beneficial in assisted reproduction technology (ART) using the long gonadotrophin-releasing hormone agonist protocol, increasing pregnancy rates and reducing ovarian hyperstimulation syndrome risk. Metformin is generally safe for both mother and neonate in successful pregnancies, but further research is needed to optimize dosage and timing.