Berkshire West Area Prescribing Committee Policy Statement What was the APC asked to consider?

Metformin for Improving Fertlity in Women with Polycycstic Ovarian Syndrome (PCOS)

Policy No:

APC 056

Date of Issue:

January 2014

Review Date:

January 2017 unless changes issued by NICE, Berkshire Priorities Committee or new evidence available before this date.

The NHS Berkshire West APC have reviewed the evidence supporting the clinical and cost effectiveness of Metformin. Standard release metformin should be HIGH PRIORITY for fertility treatment for patients with PCOS. Modified release metformin should be LOW PRIORITY for fertility treatment for patients with PCOS. Key Points considered: -

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The committee noted that there was published evidence that metformin is of benefit in improving clinical pregnancy and ovulation rates but there is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene The committee also noted that there were no direct trials comparing modified release metformin with standard release metformin One study concluded that compliance with metformin was not a factor in low success rates

References: 1. Catalado NA, Barnhart HX, Legro RS, Myers ER et al. Extended-release metformin does not reduce the clomiphene citrate dose required to induce ovulation in polycystic ovary syndrome. Journal of Clinical Endocrinology & Metabolism 2008; 93(8): 3124-3127 2. Legro RS, Barnhart HX, Schlaff WD, Carr BR, et al. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. New England Journal of Medicine 2007; 356(6): 551-566 3. McGovern PG, Carson SA, Barnhart HX, Myers ER et al. Medication adherence and treatment success in the national institute of child health and human development-reproductive medicine network’s pregnancy in polycystic ovary syndrome trial. Fertility and Sterility 2008; 90(4): 12831286

Date taken to EPC:

8th January 2014

Date Ratified by GP MOC on Behalf of Board:

15th January 2014

Berkshire West Area Prescribing Policies serve as a guide to clinicians. This does not overrule the clinical or budgetary responsibility of clinicians when considering treatment for individual patients.