Metformin vs. Clomid...where should I start?

[Anne12]

We have been TTC for 7 months now. I am 37 years old (so "advanced" maternal age), and I have been charting/using OPKs the entire time we have been TTC. We already have two children, and I'm not 100% convinced I want to go to extreme measures to have a third.

I have a follow-up appointment with my OB/GYN in a few weeks, and I'm wondering what the next steps should be. She mentioned Clomid at our last appointment, but I'm not sure if I want to start taking it...I think I'd like to try metformin first. Some info about me:

- diagnosed with PCOS about 6 months ago based on ultrasound
- I ovulate every month (clear temp shift when I chart)
- I am not very overweight (could lose 10-15 pounds...most of which has crept on in the past 2 years)
- no issues conceiving 1st child, 15 months to conceive 2nd child, but I only charted for the last 2 cycles that time
- haven't had the levels tested, but I'm pretty sure I have the signs of high testostorone (excess hair, acne, etc.)

I'm thinking that since I'm already ovulating, maybe clomid isn't right for me? Doesn't clomid just help you ovulate? I'm thinking of asking her to prescribe metformin for me to try instead...kind of hoping I can regulate my hormones and possibly lose a few pounds along with getting pregnant.

Any thoughts/suggestions? Any ideas of questions I should ask at my next appointment? Thanks!

[Esmy]

I think Metformin is a great choice to start off with. It can regulate the hormones that are out of balance when PCOS is interfering. And as you said, you can try Clomid after if the Metformin doesn't do it for ya.

[Pumpkynz]

I would start with Metformin for a few cycles. I also ovulate on my own and get clear temp shifts. But my ovulations are weak based on my progesterone level 7 dpo. Because of that I need clomid or Femara to help produce a better quality egg.

[Anne12]

Thanks ladies!

[RMMien]

If you are insulin resistant (bloodwork will let you know) you should start with metformin for a few months. Clomid or femara (from what I understand) doesn't make you ovulate. It helps follicles develop into a large enough size that they can release. If you aren't ovulating on your own you will most likely need a trigger shot to do that.

[DiamondInTheRough]

If I had to do it all over again, I would have started with Metformin. Even if your bloodwork doesn't indicate IR, it can be helpful. Mine didn't indicate IR, yet I started ovulating immediately and conceived my youngest within 5 months.

[vancouverNicole]

I was going to say the same thing about getting on Met even if you're not IR.

[Anne12]

Thanks again for the responses ladies.

Well, got my frickin' period again this morning...here we go again. I really don't want to waste another cycle before trying metformin, but my appointment isn't until the first week of May. Can a GP prescribe met, or does it have to be an ob/gyn? I think I might just ask my GP to prescribe it for me this week and start right away if it is possible...thanks!

[Esmy]

If you have a good rapport with your doctor and there's an understanding of what needs to be next and they agree, they should be able to just call it in. Ask them!

[vancouverNicole]

You don't have to start met at a particular point in your cycle, and your GP can prescribe it.

[Anne12]

Thanks!

[want2brd]

I agree with the advice you've received on here. I've been taking Met even though I don't think I'm IR (I wasn't when I was tested in 2002 and things seemed fine a couple of years ago), and I don't ovulate on my own. I did get a CD 24 ovulation with Met (and I think acupuncture helped) and got pg, but I lost that one. I am really advanced maternal age (41.5), and I think my egg quality is so-so. I think Met is a great place to start. Clomid always gives me cysts.

Just keep in mind that the Met has some GI side effects that can range from mild (what I had) to fairly heavy. The doc usually starts you on a lower dose and you ramp up over a couple of weeks. Also, it will usually take a little time for the Met to make a difference.

Acupuncture could also help regulate your hormones and improve egg quality. I have been doing it for a couple of months and I think it's really helped with some things already. Best of luck to you!

[vancouverNicole]

I didn't do well with the side effects from regular met, but glucopage (extended release met) has been great. Just as another option.

[want2brd]

Vancouver - do you only have to take the ER version once per day? I think the OB who prescribed it for me said the ER version wasn't shown to be as effective for PCOS. I fired him for other reasons, so who knows. I just *hate* having to take that stupid pill 3 times per day!!! Many days I forget at least one dose.

[vancouverNicole]

Yah, I take 3 huge pills once a day (with dinner). Interesting about it not being as effective... For me it is pretty much the only way i can get my dose up to 1500mgs, I could never get that high with regular met.