Polycystic Ovarian Syndrome Fertility Treatment with

Polycystic Ovarian Syndrome Fertility Treatment with Metformin (Glucophage)

Page author Richard Sherbahn MD

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).

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:

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.

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.

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.

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.

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

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:

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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Polycystic Ovarian Syndrome Fertility Treatment with

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