Polycystic ovarian syndrome (PCOS), also known as PCOD (polycystic ovarian disease) is a very common cause of infertility. The women who suffer from this have small ovarian cysts which get formed when there is a disruption in the regular changes of a normal menstrual cycle. The ovary gets enlarged and it produces excessive amounts of the hormones- estrogen and androgen. This condition is also called the Stein-Leventhal Syndrome.

The excess hormones that are present, in addition to the absence of ovulation, can cause infertility. In the case of an infertile patient, the treatment for PCOD typically focuses on inducing ovulation to help them conceive.

Ovulation Induction

Conventionally, the drug that is commonly used to induce ovulation in patients who have PCOD is clomiphene (Clomid). Now, doctors know that most patients who have PCOD also have insulin resistance. This particular condition is also very common in diabetics; their body also responds to the insulin in a much blunted manner.

Metformin- How this drug helps

This is also the reason why certain patients who have PCOD & don’t really respond well to treatment with Clomiphene, will be treated with antidiabetic drugs, like metformin (Glyciphage, Glucophage). A number of studies have shown that these insulin sensitizing drugs (they improve the response of the body’s cells to insulin), have the ability to improve the fertility of the patient. The drugs reverse the patient’s endocrine abnormality and improve their ovulatory response

The treatment of choice

For a number of infertile couples who have PCOD, metformin becomes the first choice of treatment. Certain infertility specialists also test for insulin resistance (they do this by measuring insulin levels post a glucose load), before they start their patients on metformin; they then select only the patients who have insulin resistance.

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. At the outset, the dose is 500 mg, twice a day with meals. Once the patient tolerates this well, the dosage is then increase to 500 mg, three times a day.

Metformin has quite a few side effects including stomach upsets, dizziness etc, but these tend to wear off with time. In the event that metformin doesn’t induce ovulation within 4 months, Clomid will have to be added to it.

Other Effects

Some studies have also found that metformin helps reduce pregnancy loss risk (this is something which is very common in patients who have PCOD. This is one of the reasons why it continues till the 16th week of pregnancy and there is no evidence that points to it increasing the risk of any birth defects.

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Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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