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Wednesday, Sep 08, 2010

Home - Metformin Use In IVF Patients

Metformin Use In IVF Patients

Metformin is an insulin-sensitizing oral medication, newly introduced as a method for treating ovulation dilemmas in patients with PCOD. There are several randomized, controlled trials and several cohort studies indicating that when taken with clomiphene citrate (ikaclomin), metformin enhances the probability of ovulation and pregnancy. However, some researchers still think that the use of metformin during stimulation is controversial.

The survey was compiled by Dr. Matan Yemini, Director of the Diamond Institute, New Jersey, USA

Metformin hydrochloride: Other generic names: Fortamet, Glucophage, Glumetza, Riomet, Glucomin, Obimet, Dianben, Diabex, Diaformin,
Tablets USP: 500 mg, 850 mg, and 1000 mg

Glucophage XR (extended release)
Tablets USP: 500 mg and 750 mg taken once daily

The following data is to assure safety and security of the information submitted. No identifying data will be published.

Name

IVF Unit Name

E-mail

1. Country

2. Estimated number of IVF cycles performed by the unit annually

3. Please describe the patients who will receive Metformin in your unit

1-All obese patients
2-Obese with anovulation (PCOD)
3-All patients with anovulation
4-Patients with glucose intolerance and insulin resistance
5-All of the above
6-Only those with clinical or biochemical signs of hyperandrogenism

4. Are PCOS and poor egg quality serve as indications for the use of Metformin in the next IVF cycle?

1-Yes
2-No

5. PCOS with habitual abortion: Is this an indication to use Metformin?

1-Yes
2-No

6. Is high insulin an indication?

1-Yes
2-No
3-I do not measure insulin level

7. Do you perform any glucose blood test before deciding on treatment with Metformin?

1-Fasting glucose test only, and treatment is initiated if pathological level is acknowledged
2-Glucose tolerance test
3-Checking glucose and insulin ratio
4-Not performing any tests related to the above

8. If you look for glucose:insulin ratio, what is abnormal?

9. When do you start Metformin treatment?

1-Up to 3 months before starting the IVF cycle
2-One month before starting the IVF cycle
3-At the time of GnRH analogue initiation in a long protocol
4-At the beginning of stimulation

10. What dosage do you prescribe?

1-Between 1500 and 2000 mg per day
2-Below 1500 mg/day
3-Above 2000 mg/day

11. Do you gradually increase the dose?

1-Yes
2-No

12. Do you monitor glucose while treating the patients with Metformin?

1-Yes
2-No

13. Using Metformin – do you prescribe the regular or the slow release?

1-Metformin regular release
2-Metformin slow release

14. Before starting treatment, apart from glucose do you look for any specific blood test, which is related to the Metformin administration?

15. Metformin is included in pregnancy category B, based on the FDA report, and is not expected to be harmful to an unborn fetus. Until what stage do you continue treatment?

16. Do you think that there is any association between Metformin and gonadotropin administration?

1-It reduces gonadotropin consumption during stimulation
2-It has no effect

17. Metformin in relation to pregnancy?

1-It increases the overall pregnancy rate although I have not tested it
2-The pregnancy rate in my unit is definitely increased
3-No correlation to pregnancy rate

18. Metformin in relation to miscarriage?

1-It reduces the rate of miscarriage, although I have not tested it
2-It definitely reduces the miscarriage rate in my unit
3-No correlation to miscarriage rate

19. Can you estimate the number of treated cycles (annually) with Metformin in your unit?

20. Is there a limit to the duration of treatment with Metformin if the patients do not conceive?

1-Yes, up to 6 months
2-No

21. Do you think that the data available in the literature is satisfactory?

1-The data is satisfactory
2-The data is insufficient for reaching a conclusion concerning this treatment modality

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