REVISION SISTEMATICA Y METAANALISIS DE LOS EFECTOS DE LA METFORMINA SOLA O EN COMBINACION CON CITRATO DE CLOMIFENO SOBRE EL SISTEMA REPRODUCTIVO EN PACIENTES CON SINDROME DE OVARIO POLIQUISTICO





REVISION SISTEMATICA Y METAANALISIS DE LOS EFECTOS DE LA METFORMINA SOLA O EN COMBINACION CON CITRATO DE CLOMIFENO SOBRE EL SISTEMA REPRODUCTIVO EN PACIENTES CON SINDROME DE OVARIO POLIQUISTICO

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La terapia previa con metformina y su administración simultánea con citrato de clomifeno incrementa los índices de ovulación y embarazo en las mujeres con síndrome de ovario poliquístico, pero no aumenta la tasa de recién nacidos vivos.
costello9.jpg Autor:
Costello, Michael Francis
Columnista Experto de SIIC

Institución:
Department of Reproductive Medicine and IVF Australia University of New South Wales Royal Hospital for Women Sydney, Australia


Artículos publicados por Costello, Michael Francis
Recepción del artículo
9 de Agosto, 2004
Primera edición
29 de Abril, 2005
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Antecedentes: Información incipiente señala que la resistencia a la insulina es un defecto determinante en el síndrome de ovario poliquístico (SOPQ) y esta asociación ha llevado al uso de fármacos sensibilizantes a la insulina, particularmente la metformina, para restaurar la ovulación y mejorar la fertilidad en las mujeres con SOPQ. El propósito de esta revisión es investigar la efectividad de la metformina, usada como agente aislado o en combinación con citrato de clomifeno (CC) para el restablecimiento de los ciclos menstruales normales y la ovulación, y para el logro del embarazo, en mujeres con SOPQ. Material, métodos y resultados: Revisión sistemática y metaanálisis de ensayos controlados aleatorizados (ECA), mediante el uso del registro central Cochrane de ensayos controlados, Medline y Embase. La información proveniente de 18 ECA, realizados sobre mujeres predominantemente obesas con SOPQ indicó que la monoterapia con metformina incrementa el índice de ovulación en las pacientes pero no contribuye al restablecimiento de las menstruaciones normales, al logro del embarazo ni al incremento de la tasa de recién nacidos vivos. La metformina combinada con CC incrementa tanto el índice de ovulación como el de embarazo, pero no la tasa de recién nacidos vivos, en comparación con el CC solo. Conclusión: La metformina sola incrementa el índice de ovulación pero no el de embarazo, de acuerdo con lo observado hasta el momento. Sin embargo, el tratamiento previo con metformina así como su coadministración con CC proporciona mejores resultados en cuanto al restablecimiento de la ovulación y el logro del embarazo en comparación con el CC solo.

Palabras clave
Síndrome de ovario poliquístico, metformina, menstruación, ovulación, embarazo, tasa de recién nacidos vivos


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Abstract
Background: Emerging evidence indicates that insulin resistance is a pivotal defect in polycystic ovary syndrome (PCOS), and this association has led to the use of insulin sensitizing drugs, particularly metformin, to restore ovulation and enhance fertility in PCOS women. The aim of this review is to investigate the effectiveness of metformin, used either as a single agent or in combination with clomiphene citrate (CC), in restoring regular menstrual cycles and ovulation and achieving pregnancy in women with PCOS. Material, methods and results: Systematic review and meta-analysis of randomised controlled trials (RCT) using the Cochrane central register of controlled trials, Medline and Embase. Data from 18 RCTs on predominately obese PCOS women indicate that metformin monotherapy improves patient ovulation rate but not restoration of regular menses, pregnancy or live birth. Metformin combined with CC improves both ovulation and pregnancy rates, but not live birth rate, compared to CC alone. Conclusion: Metformin alone improves ovulation but not pregnancy at this point in time. However, metformin as pre-treatment and co-treatment with CC is superior to CC alone in restoring ovulation and achieving pregnancy.

Key words
Polycystic ovary syndrome, metformin, menses, ovulation, pregnancy, live birth


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Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Medicina Reproductiva, Obstetricia y Ginecología
Relacionadas: Endocrinología y Metabolismo, Farmacología, Medicina Farmacéutica, Medicina Interna



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Bibliografía del artículo
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