Metformin

Polycystic ovarian syndrome (PCOS) is a common cause of infertility with an incidence of approximately 10% in females of reproductive age and much higher in those who are infertile. One hallmark diagnostic parameter of PCOS is elevated levels of male hormones, known as androgens.   PCOS is also usually accompanied by abnormally elevated levels of insulin leading to a condition known as hyperinsulinemia.  The cells within the pancreas do not respond normally to a given amount of glucose.

When insulin levels are chronically elevated, the ovary overproduces androgens leading to the deleterious effects of PCOS. Metformin belongs to a class of fertility drugs known as “insulin sensitizing agents”.  Metformin increases the insulin sensitivity of the cells within the pancreas leading to lower circulating levels of insulin and thus decreased androgen production.  Once androgen levels approach normal, natural ovulation will often resume.

Metformin is different from Clomid and FSH (Gonal-F,Follistim, Repronex, Bravelle, Menopur) in that it does not stimulate ovulation. Rather, it reestablishes a physiologic balance between androgens and insulin allowing ovulation to resume naturally.

Chronic hyperinsulinemia can have serious health consequences, including the development of Type II diabetes and increased risk for cardiovascular disease. For this reason, some specialists prescribe Metformin “long term”,  not just for the periods when pregnancy is attempted.

Metformin is usually administered at a dose of 500 mg three times daily (1,500 mg daily).  If Metformin alone is not sufficient, Clomid or FSH can be added to the treatment regimen. PCOS patients should be managed by a reproductive endocrinologist, fertility specialist thoroughly trained in the use of fertility drugs. These patients sometimes have exaggerated responses, especially to FSH that can lead to serious side effects (ovarian hyperstimulation syndrome) that can require hospitalization.