BRIEF REPORT: Spontaneous singleton and twin pregnancy in two patients with polycystic ovary syndrome and type 2 diabetes following treatment with metformin combined with rosiglitazone

Polycystic ovary syndrome (PCOS) is a complex disorder affecting about 5% to 15% of women in the reproductive age group and accounting for 75% of cases of anovulatory infertility.1 Women with PCOS have a significant degree of insulin resistance and compensatory hyperinsulinemia2 and a high prevalence of type 2 diabetes has been documented in these women.3 Hyperinsulinaemia in PCOS has been observed to lead to hyperandrogenism, which creates a hostile hormonal milieu for ovulatory cycles and for conception to occur .Thus, targeting insulin resistance and hyperinsulinemia can favourably alter the hormonal environment allowing ovulation and conception.There is some evidence to suggest that the thiazolidinediones may alter the intra-ovarian hormonal milieu of women with PCOS. Aziz et al reported that troglitazone improves defects in insulin action, insulin secretion and ovarian steroidogenesis in women with PCOS. Rosiglitazone has been reported to improve insulin sensitivity, and improve the menstrual pattern, decrease ovarian androgen production and improve ovulatory cycles in women with PCOS. The use of rosiglitazone in a young woman with PCOS has ameliorated insulin resistance, lowered androgen levels and helped spontaneous conception.Recently Vaughan and Bell reported a 46-year-old woman with PCOS who conceived spontaneously following the use of rosiglitazone to treat supervening diabetes. We report two women with PCOS and longstanding primary infertility, where the addition of rosiglitazone to metformin to treat type 2 diabetes resulted in spontaneous pregnancy with a viable singleton baby in the first woman and twin babies in the second case.