Sarwat Jehan, Peter Baillie.
The changing face of medicine in the 21st century - the example of infertile clomid failed insulin.
Baqai J Health Sci Jan ;17(12):15-24.

The outcome of metformin administration in insulin resistant infertile polycystic ovary syndrome (PCOS) patients who had failed clomid. The research was conducted at the University Assisted Reproductive Techniques (ART) Institute in Pakistan – a developing country with a high prevalence of diabetes. 166 PCOS patients submitted to ART out of 277 referrals (59.9%). Of these 78 (47%) achieved pregnancies with 75.6% take home babies and 24.4% reproductive failure prior to ART, Intra Cytoplasmic Sperm Injection (ICSI) and In Vitro Fertilization (IVF)). The total healthy take home baby rate was 47% of the 166 patients. These seventy eight (78) patients became pregnant prior to ART after starting metformin for insulin resistance. 88 required ART and 19 of these delivered a healthy baby. Metformin (500 to 2500 mg daily) was started prior to pregnancy and continued throughout pregnancy. Metformin 1500 mg daily for 3 months resulted in 59 live and well neonates averaging 3.1kg. Metformin <1500 mg daily and / or administration for less than 3 months prior to Pregnancy resulted in 18 abortions and 1 intrauterine death at 30 weeks gestation with no live neonate. Almost 50% became pregnant without ART. When ART was needed 19 out of 88 patients delivered a live baby. Almost 50% of patients with failed ART elsewhere became pregnant on this regime with take home healthy babies and 6 did not require ART. Metformin 1500mg daily administrated for at least 3 months prior to pregnancy and continued throughout pregnancy had an uncomplicated neonatal outcome in 59 patients compared to lower doses or shorter duration of administration in 19 patients who had a uniformly poor pregnancy outcome. The European Society of Human Reproduction and Embryology (ESHRE) and American Society for Reproductive Society (ASRM) guidelines are biologically and statistically flawed. In South Asia infertile PCOS patients require a long term life cycle approach. Early insulin resistance should be evaluated and metformin is the drug of choice in our hands. This has major implications for the life cycle of the patient, particularly as type II diabetes is now considered to be reversible.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com