Metformin recommended for PCOS infertility ONLY if cyster is gluclose intolerant

KatCarney · 02-14-2008, 04:57 PM

Fertil Steril. 2008 Feb 1 [Epub ahead of print] Links

Consensus on infertility treatment related to polycystic ovary syndrome.

The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group March 2–3, 2007, Thessaloniki, Greece..

The treatment of infertile women with polycystic ovary syndrome (PCOS) is surrounded by many controversies. On the basis of the currently available evidence, a group of experts reached a consensus regarding the therapeutic challenges raised in these women.

Before any intervention is initiated, preconceptional counseling should be provided emphasizing the importance of lifestyle, especially weight reduction and exercise in overweight women, smoking, and alcohol consumption.

The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC).

Recommended second-line intervention, should CC fail to result in pregnancy, is either exogenous gonadotropins or laparoscopic ovarian surgery (LOS). The use of exogenous gonadotropins is associated with increased chances for multiple pregnancy, and, therefore, intense monitoring of ovarian response is required.

Laparoscopic ovarian surgery alone is usually effective in less than 50% of women, and additional ovulation induction medication is required under those circumstances. Overall, ovulation induction (representing the CC-gonadotropin paradigm) is reported to be highly effective with a cumulative singleton live-birth rate of 72%.

Recommended third-line treatment is in vitro fertilization (IVF).

More patient-tailored approaches should be developed for ovulation induction based on initial screening characteristics of women with PCOS.

Such approaches may result in deviation from the above mentioned first-line, second-line, or third-line ovulation strategies in well-defined subsets of patients.

Metformin use in PCOS should be restricted to women with glucose intolerance. Based on recent data available in the literature, the routine use of this drug in ovulation induction is not recommended.

Insufficient evidence is currently available to recommend the clinical use of aromatase inhibitors for routine ovulation induction. Even singleton pregnancies in PCOS are associated with increased health risk for both the mother and the fetus.

carliemarie16 · 02-15-2008, 12:54 AM

What can happen to someone who isn't IR and taking metformin?

ilovebailey · 02-15-2008, 09:40 PM

Quote:

Originally Posted by carliemarie16

What can happen to someone who isn't IR and taking metformin?

Good question b/c I am in that category!! The problem with this is that if their first option doesn't work, #2 and 3 cost a fortune that I don't have and certainly won't be paying without first giving met a try.

coffeelady · 02-16-2008, 02:19 AM

same here. i just started met about 10 days ago. i was IR a few years ago when i had bloodwork done, but this time i wasn't, so she put me on it to try to start af and help me lose weight... anyone know what might happen to someone not IR on it yet?

ilovebailey · 02-17-2008, 09:52 PM

I don't think we should really worry. I've seen dozens of studies saying met is good for non-IR cysters and this is the first time I've ever read an article saying anything bad.

KatCarney · 02-17-2008, 10:12 PM

Quote:

Originally Posted by ilovebailey

I don't think we should really worry. I've seen dozens of studies saying met is good for non-IR cysters and this is the first time I've ever read an article saying anything bad.

I don't know that this article is saying anything 'bad', per se.

It's just looking at the order of treatments a women should take if she has PCOS and is TTC. This is not the first article suggesting that met is 'not' the firstline treatment for pcos and ttc...

I'm not suggesting what is right or wrong, but it's always good to read the research and know what's out there.

ilovebailey · 02-17-2008, 10:31 PM

That last sentence is what had me worried that it was saying something bad could happen, but maybe I misinterpretted, now that I am looking back...

Insufficient evidence is currently available to recommend the clinical use of aromatase inhibitors for routine ovulation induction. Even singleton pregnancies in PCOS are associated with increased health risk for both the mother and the fetus.

I totally appreciate all of the articles, being informed is a must in the ttc process!

my2babies9806 · 02-18-2008, 10:52 PM

Hmmm...ironically Met IS the first thing my dr tried me on, and my Met miracle is asleep in her crib right now. We're both totally healthy and nothing bad happened. I'm using Met again now, and I have to say, I will use it every other time I ttc. I love it, and I think its great.

KatCarney · 02-18-2008, 11:05 PM

Quote:

Originally Posted by my2babies9806

Hmmm...ironically Met IS the first thing my dr tried me on...

Were you glucose intolerant?

sheepiegirl · 02-19-2008, 12:03 PM

Met is the first thing my doctor prescribed for me too, and I'm not IR (as far as I know), and I'm thin. That's just his first step approach (especially since I was about to begin the whole TTC process). Met also didn't seem to do anything for me (although I didn't have bloodwork or anything to see if those levels changed).

I don't think anything *bad* will happen if a non IR person takes Met, but I just don't think it will do anything much at all.

REW · 02-19-2008, 12:35 PM

My OB actually attended the conference where this study was released. My OB is now following the recommendations of this study, though he found it surprising as Met seemed to help some of his patients that would not necessarily fall into the glucose intolerant group and were not being successful even with injections. At the conference my OB also spoke to the lead guy from the study about all this and asked him what he was going to do and the researcher said he was still going to use Met. Go figure.

Snowbunny74 · 02-20-2008, 10:43 AM

I dont think im particularly glucose intolerant but im on met, and my periods have started again. they are a bit long, about 2wks from start to end but there there. sometimes i wish they werent.

my2babies9806 · 02-21-2008, 02:46 AM

Kat - when I was diagnosed with PCOS, it was based on the wacky cycles, weight issues, and cysts on my ovaries. I was told to go on bcp for 3 months to absorb the cysts and then have another u/s to see if my ovaries were clear. If they were, I was to start Met. Well, they were clear and I started Met. 2 days later I went to the lab for bloodwork and a week later I got the results I am in fact IR. But we didnt know that when I was put on the Met. I was already taking it for 8 or 9 days when we found out. My dr said she had seen it work well in other PCOS patients she had who were ttc so she figured we'd try it and see. And it works WONDERFULLY, so now we stick with it.

KatCarney · 02-21-2008, 11:56 AM

Quote:

Originally Posted by my2babies9806

Kat - when I was diagnosed with PCOS, it was based on the wacky cycles, weight issues, and cysts on my ovaries. I was told to go on bcp for 3 months to absorb the cysts and then have another u/s to see if my ovaries were clear. If they were, I was to start Met. Well, they were clear and I started Met. 2 days later I went to the lab for bloodwork and a week later I got the results I am in fact IR. But we didnt know that when I was put on the Met. I was already taking it for 8 or 9 days when we found out. My dr said she had seen it work well in other PCOS patients she had who were ttc so she figured we'd try it and see. And it works WONDERFULLY, so now we stick with it.

So based on that, Met was 'not' the first thing you were put on...BCP's were

my2babies9806 · 02-21-2008, 12:03 PM

LOL..you're right, although you know what I meant...LOL