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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.

Read more- Polycystic Ovarian Disease - PCOD

How these drugs help

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.

The Chosen Treatment

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
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.

Other Effects

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.

Read more- How to manage your PCOD

Summary

Treatment of PCOD for the infertile patient will usually focus on inducing ovulation to help them conceive.