Medications

Metformin, Glucophage

Metformin/Glucophage works by suppressing hepatic glucose production and increasing glucose utilization in peripheral tissues. It cannot be used in all women including those who have kidney or liver disease. Common side effects include nausea and diarrhea, which usually lessen over time and usually abate after 3-4 weeks at the same dose. Dr. Allon prefers to prescribe the extended release glucophage as it has lower side effects and these can be minimized if the medication is taken with meals. See our separate page on Metformin and PCOS. 

Some fertility specialists prescribe insulin-sensitizing medications to women with PCOS regardless of their insulin sensitivity. In addition, insulin-sensitizing medications can be used while trying to conceive. Even though more studies are needed to firmly establish the benefits, many improvements in symptoms are seen and ovulation resumes.
Metformin should not be taken for 48 hours prior to any X-ray procedure in which iodinated compounds will be used, including the hysterosalpingogram (HSG) where contrast dye is injected into the uterus.

If an insulin-sensitizing medication is taken for 3-6 months without ovulation or pregnancy, then additional fertility medications may be considered. Ovulation stimulation drugs, such as Clomid, letrozole and FSH, can be taken in conjunction with insulin-sensitizing medication .

Clomid with Metformin

Clomid is an oral medication used to induce and regulate ovulation. In PCOS patients it has been shown to work better when used in combination with Metformin (500mg three times a day) to improve pregnancy success rate.

Letrozole with Metformin

Letrozole is an aromatase inhibitor and works like Clomid. It induces ovulation and their effects are improved when used in combination with Metformin. The risk of twins with Letrozole is about 5%.

Injectable medication- FSH

Gonal-F, Follistim, Repronex, and Bravelle, are medications used to directly stimulate the ovary to produce several follicles and improve pregnancy rate. These medications are used when we are unable to stimulate the ovary with oral medications.