|
Treatment of PCOD for the infertile patient will usually focus on inducing ovulation to help them conceive.
Ovulation Induction:
Traditionally, the drug of first choice for ovulation induction in patients with
PCOD has been clomiphene(clomid)
.
Doctors have now learned that
many patients with PCOD also have insulin resistance - a condition similar to that found in
diabetics, in that they have raised levels of insulin in their blood ( hyperinsulinemia) , and their response
to insulin is blunted. This is why some patients with PCOD who do not respond
to clomiphene are treated with antidiabetic drugs, such as metformin ( Glyciphage, Glucophage). Studies
have shown that these drugs which are insulin sensitisers ( they improve the response of
the body's cells to insulin) can help to improve their fertility by reversing their
endocrine abnormality and thus improving their ovulatory response.
For many infertile patients with PCOD, metformin is the first choice of treatment. Some doctors will
test for insulin resistance ( by measuring serum insulin levels after a glucose load)
before starting metformin, and select only those patients who have proven insulin resistance.
The starting dose is 500 mg, twice a day, with meals; and this is then
increased to 500 mg thrice a day, once the patient tolerates it well. Metformin
does have a number of side-effects, such as dizziness and stomach upsets, but these usually wear off with time.
If metformin fails to induce ovulation within 4 months, then clomid can be added to it.
Interestingly, many studies have found that metformin helps to reduce the
risk of pregnancy loss which is often seen in patients
with PCOD. This is why it is often continued till 16
weeks of pregnancy. It does not seem to increase the
risk of birth defects.
Also Read
|
