FRIDAY, Feb. 3 (HealthDay News) -- Metformin alone or in combination with clomiphene may increase the risk of higher-order multiple births in some women with polycystic ovary syndrome, according to two case reports in the January issue of Fertility and Sterility.
Clare Boothroyd, M.B. and Anusch Yazdani, M.B., of the Greenslopes Specialist Centre in Brisbane, Queensland, Australia, describe the case of an obese 30-year-old nulliparous woman with a 10-year history of polycystic ovary syndrome. The patient was placed on clomiphene 50 milligrams per day for five days per cycle, but failed to conceive. Metformin 500 mg three times a day was then added. A trichorionic pregnancy occurred, but one of the fetuses died at seven weeks gestation. The woman was delivered of healthy twins at 30 weeks gestation.
The second case was of a lean 31-year-old woman with polycystic ovary syndrome. Cabergoline failed to induce ovulation. Induction with five days of clomiphene 50 mg per day also failed to induce ovulation and was stopped at the patient's request. Metformin 500 mg three times daily resulted in a singleton pregnancy, which miscarried. Clomiphene 75 mg daily for five days plus metformin 500 mg three times daily resulted in a trichorionic pregnancy. Selective fetal reduction was done and she was delivered of healthy twins at 37 weeks gestation.
"It is not possible to make proscriptive recommendations from these two cases," the authors conclude. "However, women undertaking ovulation induction need to be counseled about the possible risk of higher-order multiple pregnancy from metformin therapy."
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