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Polycystic Ovarian Syndrome Fertility Treatment with Metformin (Glucophage)

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How Metformin Is Used for Polycystic Ovaries

Polycystic ovarian syndrome is a common cause of anovulation and infertility in women. These women do not ovulate (release eggs) regularly and therefore have irregular menstrual periods.

The ovaries have many small cysts (2-7 mm diameter) called antral follicles, giving the ovaries a characteristic "polycystic" (many cysts) appearance on ultrasound.

A relatively new method of treating ovulation problems in women with polycystic ovarian disease is to use an oral medication called metformin (brand name is Glucophage).

PCOS ovary
Ultrasound PCOS picture
Polycystic ovary at "PCO"
Bowel at "B"
Metformin has traditionally been used as an oral drug to help control diabetes. Then, some smart doctor figured out that polycystic ovarian syndrome treatment with metformin can be very effective.

If Glucophage alone does not result in ovulation and pregnancy, we often use:

If the combination therapy is not effective, we can try:

Metformin Use with IVF Treatment

We also use Glucophage in women going through in vitro fertilization for PCOS, and for those with very high antral follicle counts - if their ovaries are "polycystic" by ultrasound.

We find that some women with polycystic ovaries respond with a "smoother" response to the injectable FSH medication if they have been taking Glucophage.

Risks and Side Effects of Metformin / Glucophage

In about 25% of women Glucophage causes side effects which may include abdominal discomfort, cramping, diarrhea and nausea. The side effects may be severe enough to make the woman stop the Glucophage medication. We are not aware of any serious complications resulting from Glucophage treatment.

Another oral medication used for diabetes called Troglitazone has been associated with liver failure and death in rare cases. This has been publicized on television shows, in newspapers, etc. These problems have not been associated with the use of metformin for polycystic ovarian syndrome.


Treatment Process for Taking Metformin

Laboratory (blood) tests that are sometimes done before starting metformin:

LH, FSH, estradiol, DHEAS, testosterone, 17-OHP, prolactin, thyroid stimulating hormone (TSH), kidney function tests (BUN, creatinine) and liver function tests (AST, ALT, and LDH).

Some doctors will do fasting blood sugar and fasting insulin levels in order to calculate a fasting glucose to insulin ratio. This is a measure of insulin resistance, which is present in some women with polycystic ovarian disease.

When to Have Intercourse

  • Patients need to be counseled regarding possibility of ovulation occurring and need for regular intercourse (about every 2-3 days) in order to maximize chances for pregnancy
  • Women should keep menstrual calendars, recording days of menstrual bleeding and intercourse

Treat polycystic ovarian syndrome with Glucophage / Metformin Alone

Metformin Dosing and Protocol

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 start metformin at 500 mg once daily, increase to 500 mg twice a day after one week, then to 500 mg 3 times daily after another week.
  • If the 3 times daily dose cannot be tolerated due to side effects, we remain on the twice-daily dose.
  • The most effective dose of Glucophage for PCOS is generally 500mg 3 times daily.

Add Clomiphene to Metformin Treatment Regimen

If the metformin does not result in ovulation and regular periods, the next step is often adding clomiphene to the regimen.

Other Treatment Options

If the combination of metformin and clomiphene does not result in ovulation then we move on to other options. We usually proceed with one of the following treatments to achieve pregnancy:

Weight Loss and Polycystic Ovarian Syndrome Treatment and Chances for Pregnancy

Some women will have polycystic ovarian syndrome and irregular or absent menstrual periods regardless of their weight. Others develop polycystic ovarian syndrome when they gain too much weight. These women are likely to resume regular ovulation if they can get back down to the weight at which they were previously ovulating.

Although doctors do not consider weight loss a "treatment", it can restore fertility or facilitate infertility treatment by making the body more responsive to fertility medications.

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