Ovarian Stockpiling in Polycystic Ovary Syndrome, Infertility, and the Combined Use of Rosiglitazone and Metformin
- Tarik A. Elhadd, MD,
- Tarek Fiad, MD and
- Lorna Meer, MD
- From the Department of Endocrinology and Department of Obstetrics and Gynecology, Dudley Group of Hospitals NHS Trust, Dudley, West Midlands, U.K.
- Address correspondence to Dr. Tarik A. Elhadd, MD, Department of Medicine, King Faisal Specialist Hospital and Research Centre, P.O. Box 40047, Jeddah 21499, Saudi Arabia. E-mail: tarikelhadd58{at}gmail.com
We read with interest the recent report by Vaughan and Bell (1), in which the addition of rosiglitazone to metformin to control glycemia in their 46-year-old patient of Euroasian decent resulted in an unplanned and unexpected, yet successful, pregnancy. This case is another anecdote for the potential usefulness of the glitazone class of drugs in treating the infertility of women with polycystic ovary syndrome (PCOS).
We recently encountered a similar situation in a woman in her 40s with a longstanding history of primary infertility due to PCOS. Her PCOS has been extensively, but ineffectively, managed since her early 20s, to the extent that she gave up hope of having children when she reached her mid-30s. She developed type 2 diabetes when she was 37 years of age, and after the addition of rosiglitazone to metformin to improve glycemia, she had an unexpected, successful pregnancy, giving birth to viable healthy twin males.
This case adds to the recent accumulating scientific usefulness of the combination of metformin and the glitazone class of drugs for improving the metabolic milieu and correcting the metabolic defects in women with PCOS (2–4). Vaughan and Bell’s case and ours suggest that the combined use of metformin and a glitazone agent may prove to be an attractive combination to tackle the infertility of women with PCOS; however, this will need to be tested by randomized controlled trials.
Though Vaughan and Bell have rightly pointed out the need to exercise caution in the use of this combination therapy and to fully counsel such women for the possibility of unexpected conception, we feel that only a randomized controlled trial will prove such safety.
Finally, such a combination may also provide some help to tackle other metabolic abnormalities of PCOS, like hirsutism and glucose intolerance (5,6).
