Although metformin is associated with better clinical pregnancy rates (positive beta hCG) (pooled OR 2.31; 95% CI: 1.52 to 3.51; 8 trials; 707 women), there is no evidence of better live birth rates (the main variable used to evaluate the effectiveness of a treatment for infertility) when this drug is used alone (pooled OR 1.80, 95% CI: 0.52 to 6.16; 3 trials; 115 women) or in combination with CC (pooled OR 1.16; 95% CI: 0.85 to 1.56; 7 trials; 907 women) 36. From a reproduction standpoint, there is also no benefit for its use in short (less than four weeks) or long (more than four weeks) periods prior to starting CC treatment in women with PCOS. Therefore, the use of metformin should be restricted to the treatment of glucose intolerance or type 2 diabetes in women with PCOS and should not be used to induce ovulation 9,36.
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