Clomid and Metformin for PCOS
Glucophage Plus Clomiphene for Fertility Treatment and Pregnancy with Polycystic Ovarian Syndrome
Page author Richard Sherbahn MD
Metformin and Clomid Use with PCOS
- Women who do not ovulate often have polycystic ovarian syndrome, or PCOS
- Clomid, also called Serophene, or clomiphene citrate is the most commonly used medication to try to induce ovulation in women that do not ovulate on their own
- Metformin (Glucophage) is an oral medication that is mainly used to treat diabetes
- However, it can also be used with PCOS to help women ovulate and achieve pregnancy.
- Some women with PCOS that do not ovulate when treated with Clomid or metformin alone could ovulate and have success when glucophage and Clomid are used together
Metformin alone for PCOS
A relatively small percentage of women that do not ovulate regularly and have polycystic ovarian disease will ovulate regularly and become pregnant from treatment with metformin alone.
- For those women that are taking metformin for PCOS and are not achieving pregnancy, a reasonable option is to add Clomid to the metformin treatment
An Alternative to Injectable FSH Medications, or IVF
Using clomiphene and metformin together can be beneficial for the women with polycystic ovarian syndrome. If they can ovulate and get pregnant with this medication combination, they can avoid the more expensive and invasive treatments such as using injectable FSH medications or in vitro fertilization for PCOS.
Side Effects of Glucophage / Metformin and Clomid for PCOS
About one fourth of women taking metformin have gastrointestinal side effects such as abdominal discomfort, diarrhea and nausea. We do not know of any serious complications from metformin treatment of PCOS.
Treatment Protocol for for Taking Metformin and Clomid to Induce Ovulation
The benefit of metformin on ovulation in women with polycystic ovaries is not seen right away. There is some benefit starting about a month after beginning metformin.
- Metformin has a more substantial benefit for fertility when the woman has been taking it for at least 60 to 90 days.
Metformin is taken in a dose that the woman can tolerate. Most people can tolerate 500 mg three times daily, if they build up to that dose gradually.
- We usually start metformin at 500 mg once daily, then increase to 500 mg twice a day after one week, then to 500 mg three times daily after another week.
- If the three times daily dose cannot be tolerated due to side effects, we remain on the twice-daily dose.
- Clomiphene is usually started at a dose of one tablet (50 mg) daily for five days
- It is started early in the menstrual cycle, usually either days 3 - 7 or days 5 - 9
- Women that have very irregular cycles usually need to have a period induced with a progestin medication such as Provera
- If 50 mg of clomiphene per day does not result in ovulation, we increase the dose in the next cycle to 100 mg per day
- If there is not ovulation at 100 mg, we either try 150 mg per day - or we give up on Clomid and move on to other fertility treatments
Clomid and Metformin for PCOS - Success Rates
It is hard to give a success rate for metformin plus Clomid for polycystic ovarian syndrome. Each case is different and factors such as female age, her weight or BMI, the sperm parameters, and other fertility issues affect chances for success.
However if we achieve ovulation, have normal sperm, and the female is under 37 years old, we could expect a pregnancy success rate of about 10 to 15% per month for intercourse around ovulation, and 15 to 20% per month for intrauterine insemination, IUI.
Success rates with IUI - insemination
We can expect those success rates to hold up for about three months. Further attempts beyond that are expected to have lower chances for success.
Other Treatment Options
If the combination of metformin and clomiphene does not result in ovulation and pregnancy, we will move on to more aggressive treatments.
Other effective PCOS treatments to achieve pregnancy after metformin and Clomid have failed: