Objective  To explore the clinical efficacy, glucose and lipid metabolism, reproductive endocrine system, endometrial receptivity, ovarian responsiveness, and pregnancy effects of metformin (MET) on obese polycystic ovary syndrome (PCOS) with infertility.

Methods  Clinical data of obese PCOS patients with infertility admitted to Wuhan Sixth Hospital from June 2021 to January 2024 were retrospective ana lyzed. According to the medication regimens, they were divided into a control group (letrozole, LET) and a combination group (MET and LET). The treatment efficacy, glucose and lipid metabolism indicators [cholesterol (TC), triglycerides (TG), fasting blood glucose (FPG), fasting insulin (FIN), and insulin resistance index (HOMA-IR)], reproductive endocrine indicators [testosterone (T), estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), anti-miller’s hormone (AMH), and LH/FSH], uterine content tolerance [endometrial thickness, spiral artery pulsatility index (PI), and resistance index (RI)], ovarian responsiveness [follicle formation time interval, the number of dominant follicles and ovulation rates], as well as pregnancy rate  were compared after the treatment (3 months). In addition, adverse reactions related to drugs during treatment were recorded to evaluate the safety.

Results  A total of 99 patients were included in the study, with 53 in the combined group and 46 in the control group. The treatment efficiency of the combined group was significantly higher than that of the control group (P<0.05). Before treatment, the differences in body mass index (BMI), TC, TG, FPG, FIN, HOMA-IR, T, E2, LH/FSH, AMH, endometrial thickness, PI and RI between the two groups were not statistically significant (P>0.05); after treatment, BMI, TC, TG, FPG, FIN, HOMA-IR, T, E2, LH/FSH, AMH, endometrial thickness, PI and RI of the patients in both groups were significantly lower than before treatment (P<0.05), and these indicators of the combined group were lower than those of the control group (P<0.05). In addition, the follicle formation time of the combined group was shorter than that of the control group, the number of dominant follicles was more than that of the control group, and the ovulation rate and cycle pregnancy rate were significantly higher than those of the control group (P<0.05); the difference in the incidence rates of adverse reactions between the two groups was not statistically significant (P>0.05).

Conclusion  MET can regulate glucose and lipid metabolism, reproductive endocrine indicators, improve endometrial receptivity, improve ovarian response, and thus increase ovulation and pregnancy rates.

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