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Evaluation of the Effect of Metformin and Folic Acid on Plasma Homocysteine Levels in Infertile Women with Polycystic Ovarian Syndrome
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Fariba Seyedoshohadaei1    , Baran Miraki2 |
1- Kurdistan University of Medical Sciences , f.seyedoshohadaei@muk.ac.ir
2- Kurdistan University of Medical Sciences |
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Abstract: (35 Views) |
Background and Objectives: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age. Patients with PCOS and insulin resistance exhibit higher homocysteine levels compared to control groups. On the other hand, insulin-sensitizing drugs such as metformin, used in the treatment of these patients, may lead to hyperhomocysteinemia. This elevation is associated with cardiovascular events as well as adverse pregnancy outcomes, including miscarriage and preeclampsia. This study aimed to evaluate homocysteine levels in women with PCOS who had normal blood glucose and fasting insulin levels, assess the effect of metformin on plasma homocysteine concentration, and determine whether metformin treatment in these individuals is beneficial and complication-free.
Materials and Methods: A cohort study was conducted on 63 infertile women with PCOS, aged 18–35 years, who had normal fasting glucose and insulin levels and were referred to Besat Hospital in Sanandaj, Iran, between 2018 and 2020. Participants were undergoing treatment for PCOS with cyproterone compound and 1 mg/day folic acid. They were divided into two groups: the first group received 1000–1500 mg of metformin daily for three months, while the second group served as the control. Serum homocysteine, fasting glucose, and fasting insulin levels were measured before and after treatment. Data were analyzed using SPSS version 17, with Mann-Whitney, Chi-square, and Fisher’s exact tests employed for statistical analysis. A p-value <0.05 was considered statistically significant.
Results: The study revealed that the mean serum homocysteine concentration before metformin administration was 10.06 ± 2.57 in the metformin group and 10.96 ± 4.95 in the control group. After three months of metformin treatment, the concentration decreased to 8.30 ± 2.45, indicating a statistically significant reduction (p=0.002).
Conclusion: In women with PCOS and normal fasting blood glucose and insulin levels, when prescribed with folic acid, metformin not only does not increase serum homocysteine levels but also significantly reduces them. Therefore, it is recommended that individuals taking metformin use folic acid to help lower homocysteine levels and mitigate the complications associated with hyperhomocysteinemia. |
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| Keywords: Homocysteine, Polycystic ovarian Syndrome, Metformin, Folic Acid |
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Type of Study: Original Research |
Subject:
Medicine - Obstetrics and Gynecology
Received: 2025/02/4 | Accepted: 2026/02/10
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