Infertility in women with polycystic ovary syndrome and the role of metformin in management

Polycystic ovary syndrome (PCOS) is one of the most common medical conditions in women of reproductive age and the most common cause of anovulatory infertility. Insulin resistance is one of the underpinning features of PCOS in most women. Metformin can improve insulin resistance and was introduced as a pharmacological agent to treat anovulation and infertility in the 1990s. Metformin does not increase ovarian hyperstimulation or multiple pregnancies and may in some clinical situations have a role as a single agent or in combination with clomiphene citrate (CC) however the evidence supports the efficacy of lifestyle intervention as first-line treatment for PCOS anovulatory infertility followed by CC. Here, we discuss the role of metformin in light of other therapies for the treatment of anovulatory infertility in women with PCOS.