Fertility in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in the United States, affecting 5% to 10% of women of reproductive age. Several treatment options exist, including those that target insulin resistance. Once pregnancy is achieved, however, women are faced with several potential complications, including early pregnancy loss (EPL), gestational diabetes mellitus (GDM), and pregnancy-induced hypertensive disorders. All these disorders are potentially linked by their association with hyperinsulinemia and insulin resistance. Preliminary studies suggest that metformin, an insulin-sensitizing agent that is a pregnancy class B drug, may decrease the risk of EPL and GDM in women with PCOS. Although it is reassuring that metformin administration during pregnancy appears to be safe, rigorous randomized controlled trials must be conducted to confirm metformin's efficacy and safety under these conditions before its use during pregnancy can be recommended.