Metformin In Women With Polycystic Ovary Syndrome For Improving Fertility
Metformin in women with polycystic ovary syndrome for improving fertility Review question: The aim of this Cochrane review was to determine the effectiveness and safety of metformin, an insulin-sensitising agent, for improving ART outcomes, especially, live birth and clinical pregnancy rates, in women with PCOS undergoing in vitro fertilisation (IVF) treatment. Background: Polycystic ovary syndrome (PCOS) is a condition characterised by chronic failure or absence of ovulation (anovulation) and excessive production of male hormones (hyperandrogenism). The main symptoms of this disorder are irregular menstrual cycles, infertility, hirsutism (excessive hair growth) and acne. This condition is the most common endocrine disorder in women, affecting approximately 5% to 10% of all women of reproductive age. Study characteristics: The review included nine randomised controlled trials involving a total of 816 women who were randomised to receive metformin (411) versus placebo or no treatment (405). The trials were conducted in the Czech Republic, Italy, Jordan, Norway, Turkey and the United Kingdom. The evidence is current to October 2014. Key results: When metformin was compared with placebo or no treatment, there was no conclusive evidence of a difference between the groups in live birth rates, but pregnancy rates were higher in the metformin group, and the risk of OHSS was lower. We estimated that for a woman with a 32 % chance of achieving a live birth using placebo , the corresponding chance using metformin would be between 28% and 53%. For a woman with a 31% chance of achieving a clinical pregnancy without metformin, the corresponding chance using metformin would be between 32% and 49%. For a woman with a 27% risk of ovarian hyperstimulation syndrome (OHSS) without metfor Continue reading >>
Can Metformin Help Women With Pcos?
Home / Fertility / Boosting Fertility We asked doctors whether the drug Metformin really helps women with PCOS conceive, reduce miscarriage risk and increase milk supply. Here's what they say. If you have polycystic ovary syndrome (PCOS), you're not alone. According to the National Center for Biotechnology Information , this hormonal disorder affects between 5 percent and 15 percent of women of reproductive age in this country. In polycystic ovary syndrome, cysts develop on the ovaries, and the body produces excess hormones called androgens, which cause an irregular menstrual cycle. As a result, ovulation can be unpredictable, and getting pregnant can be challenging. "Since puberty, I've averaged one menstrual cycle per year," says Carrie, a mother from the Midwest who has PCOS. "I always wondered if I could have children." Carrie tried getting pregnant for several months, but wasn't able to because she wasn't ovulating. After evaluating her bloodwork, her OB/GYN suggested she go on either Clomid or Metformin to help balance her hormones to promote ovulation. "Because I had a very slight imbalance in my hormones, my doctor suggested trying Metformin before going straight to Clomid. Since I heard horror stories about Clomid causing multiples, I was happy to try Metformin first," Carrie says. Metformin is a diabetes medication that is sometimes used to regulate hormones in women with PCOS by balancing their insulin level. This effect leads to more regular menstruation and ovulation cycles , according to WebMD . Carrie got pregnant the first month she took Metformin. But not all women with polycystic ovary syndrome have such good results. In fact, experts say more evidence is needed to prove that Metformin helps conception in PCOS patients . "When putting all the data tog Continue reading >>
Metformin Use In Women With Polycystic Ovary Syndrome
Metformin use in women with polycystic ovary syndrome 1Robinson Institute, University of Adelaide, Adelaide, Australia; 2University of Auckland, Auckland, New Zealand; 3Repromed Auckland, 105 Remuera Road, Auckland, New Zealand; 4Auckland Gynaecology Group, 105 Remuera Road, Auckland, New Zealand; 5Fertility Plus, National Womens Health, Auckland District Health Board, Green Lane Clinical Centre, Auckland, New Zealand Received 2014 Apr 1; Accepted 2014 Apr 17. Copyright 2014 Annals of Translational Medicine. All rights reserved. This article has been cited by other articles in PMC. Polycystic ovary syndrome (PCOS) is an endocrinopathy characterised by increased resistance to insulin. Metformin is one of the longest established oral insulin sensitising agents. For decades its use was restricted to management of type 2 diabetes. However, in the past two decades, its properties as an insulin sensitising agent have been explored in relation to its applicability for women with PCOS. Metformin is an effective ovulation induction agent for non-obese women with PCOS and offers some advantages over other first line treatments for anovulatory infertility such as clomiphene. For clomiphene-resistant women, metformin alone or in combination with clomiphene is an effective next step. Women with PCOS undergoing in vitro fertilisation should be offered metformin to reduce their risk of ovarian hyperstimulation syndrome. Limited evidence suggests that metformin may be a suitable alternative to the oral contraceptive pill (OCP) for treating hyperandrogenic symptoms of PCOS including hirsutism and acne. More research is required to define whether metformin has a role in improving long term health outcomes for women with PCOS, including the prevention of diabetes, cardiovascular disease Continue reading >>
Does Metformin Make You More Fertile?
It's an increasingly common phenomenon: A drug that was originally synthesized for a specific purpose turns out to be effective in combating another problem. Examples include Viagra (an unsuccessful treatment for angina that succeeded as an erectile dysfunction drug) and Thalidomide, a disastrously ineffective medication for pregnancy-induced nausea that has been proven to fight bone marrow cancer [source: Brown]. Metformin can also be included in this list, but with one significant difference. Not only is it helpful in a secondary role, but it's wildly popular in treating the condition for which it was initially intended. Metformin was developed in the 1950s as a treatment for diabetes [source: Diabetes Forecast]. Today it's the most popular drug on the market for people with Type 2 diabetes [source: Science Daily]. But by 2004, Metformin was receiving international acknowledgement as a worthwhile option for patients seeking a remedy for their infertility. The U.K.'s National Collaborating Centre for Women and Children's Health noted that the drug, when used in conjunction with other medications, improved the rate of pregnancy in women with specific infertility issues tied to ovaries containing multiple cysts [source: NCCWCH]. The common denominator between Type 2 diabetes, Metformin and infertility can be described in one word: insulin. Insulin carries blood sugar to the body's cells to create energy. Some people's bodies, however, produce too little insulin, or the cells in the body refuse to accept the sugar it's transporting [source: American Diabetes Association]. That can lead to a multitude of health issues. Women whose infertility is tied to polycystic (multiple cysts) ovarian syndrome often have issues with insulin resistance. That's where Metformin comes in. Continue reading >>
Glucophage (Metformin) for the Treatment of PCOS Polycystic ovary syndrome (PCOS) is a common condition characterized by failure to ovulate (and irregular menstrual periods), a tendency toward excess body hair and acne and/or oily skin. It is estimated that one in twenty reproductive age women have PCOS. While this is a common problem in the infertile population, the cause of this condition is still not completely understood. There is new information to suggest that the underlying cause in many women with PCOS is insulin resistance. Women with this condition are not diabetic-their blood sugar levels are normal-however, their insulin levels are frequently elevated. Lowering the insulin levels acts to decrease elevated levels of male-type hormones (such as Testosterone) and, in many cases, restores ovulation and normal fertility. Treatment of infertility for women with PCOS is ovulation induction with clomiphene citrate (Clomid, Serophene) and/or metformin. For those who fail to ovulate in response to clomiphene citrate alone, treatment with Metformin may be added. Metformin does not have a F.D.A. indication for its use in PCOS but there is substantial research on the application of Metformin in this setting and Metformin is being used at reproductive endocrinology and infertility clinics around the world for this common problem. Metformin has no effect on insulin production per se but facilitates insulin action in the body so that the body will naturally make less of it. It should not be used in women with insulin-dependent diabetes, liver dysfunction, kidney disease, or who are exposed to IVP dye (for X-ray testing of the kidneys). It should not be used in times of acute physical stress such as severe illness (influenza), surgery or recovery from significant trauma. Deh Continue reading >>
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Many infertility problems don’t require assisted conception techniques, such as in vitro fertilisation (IVF), but can be treated with simpler methods. The treatments you will be offered will depend on the cause of your infertility. If you are not ovulating properly, you may be offered either medication to correct the cause or fertility drugs to stimulate the ovaries. If you have blocked or damaged fallopian tubes, you may need surgery, either as an open operation or, increasingly, by laparoscopy (‘keyhole’ surgery). Disorders of sperm function respond poorly to drug treatment. Instead, you may be offered sperm donation or assisted conception (for more details, see later sections). Drug treatment for endometriosis does not improve fertility. OVULATION INDUCTION If you are not ovulating or do so irregularly, your chances of conceiving are obviously diminished. There are several causes of ovulation failure, and most cause either a complete absence of menstrual periods (amenorrhoea) or infrequent periods (oligomenorrhoea). Provided you have not gone through an early menopause, the available treatments are generally very effective. Some conditions that may require more complex medical treatment or, occasionally, even surgical treatment include: hypopituitarism (underactivity of the pituitary gland, which leads to less follicle-stimulating hormone (FSH) and luteinising hormone (LH) being produced); hypogonadotrophic hypogonadism (poor ovarian activity caused by inadequate stimulation of the pituitary gland); hyperprolactinaemia (excessive prolactin hormone production by a small benign (non-cancerous) tumour of the pituitary gland) and polycystic ovary syndrome (where the hormone signals to the ovaries are unbalanced, leading to development of multiple immature egg sacs) Continue reading >>
Polycystic Ovary Syndrome And Pregnancy: Is Metformin The Magic Bullet?
This article reviews the literature regarding the effects of metformin therapy in pregnant women with polycystic ovary syndrome on weight loss, fertility, early pregnancy loss, malformations, gestational diabetes mellitus, perinatal mortality, placental clearance, lactation, and early childhood development. The pharmacology of metformin is also presented. Preliminary data suggest that metformin for this population may be both safe and effective. Large blinded, randomized clinical trials are underway to confirm the preliminary safety data. History of Polycystic Ovary Syndrome Although the first description of polycystic ovary syndrome (PCOS) is generally credited to Stein and Leventhal in 1935, it may have been observed as early as 1721, when the Italian scientist Antonio Vallisneri observed “young married peasant women, moderately obese and infertile, with two larger than normal ovaries, bumpy and shiny, whitish, just like pigeon eggs.”1 This depiction sounds strikingly similar to the subfertility and obesity commonly found in PCOS. It was not until 1921 that Achard and Theirs2 noticed a relationship between hyperandrogenism and insulin resistance in their study of the “bearded diabetic woman.” And in 1935, Stein and Leventhal3 made the connection between amenorrhea and polycystic ovaries. In addition, they also noticed the occurrence of masculinizing changes, such as hirsutism and acne, in many patients with polycystic ovaries. Several, but not all, of Stein and Leventhal's original case studies involved women who were overweight. In all seven of their case reports, attempts to treat ovulatory dysfunction with estrogenic hormone failed, and wedge resection was employed. All of their patients gained normal menstruation, and two became pregnant. Surgery for PCOS Continue reading >>
Metformin In The Treatment Of Infertility In Pcos: An Alternative Perspective
Metformin in the Treatment of Infertility in PCOS: An Alternative Perspective Departments of Internal Medicine, Obstetrics and Gynecology, and Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298 John E. Nestler, Departments of Internal Medicine, Obstetrics and Gynecology, and Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298; Address all correspondence and reprint requests to: John E. Nestler, M.D., Division of Endocrinology and Metabolism, Medical College of Virginia, P.O. Box 980111, Richmond, VA 23298-0111 The publisher's final edited version of this article is available at Fertil Steril See other articles in PMC that cite the published article. This editorial discusses the recent ESHRE/ASRM recommendations on the treatment of infertility in PCOS. Evidence is provided for the use of metformin in selected patients. In 2007, the European Society for Human Reproduction and Embryology (EHSRE) and the American Society for Reproductive Medicine (ASRM) sponsored a workshop to discuss the therapeutic challenges of infertility and the polycystic ovary syndrome (PCOS), out of which a consensus paper emerged ( 1 ). The consensus statement offered a bleak view of the use of metformin in infertility, recommending that metformin use in PCOS should be restricted to women with glucose intolerance. In this editorial, I offer a perspective on the use of metformin for the treatment of infertility in PCOS that differs significantly from the consensus statement. My aim is to provide a strategy that addresses the needs not only of the reproductive endocrinologist, whose patients often desire pregnancy immediately, but also the gynecologist, medical endocrinologist and others, whose patients' time lines for achieving pregnancy Continue reading >>
Opinion Article The Role Of Metformin In Ovulation Induction: Current Status
To define the exact role of metformin in ovulation induction, it is crucial to distinguish three different indications: naïve PCOS, CC-resistant PCOS and ART. In naïve PCOS: metformin as compared to placebo has been shown to improve ovulation rates, but metformin did not exert significant advantage over CC with respect to cumulative ovulation, pregnancy or live-birth rates. The combined approach of metformin plus CC is not better than CC or metformin monotherapy in naïve PCOS. In CC-resistant patients: metformin has no benefit over placebo in ovulation, pregnancy, and live-birth rates as a single agent, but the combination of metformin and CC significantly improved ovulation and pregnancy rates when compared with CC alone. However, combined therapy did not improve the odds of live birth. Metformin pretreatment improves the efficacy of CC in PCOS patients with CC resistance. In PCOS patients scheduled for ART: metformin addition to gonadotropins reduces the duration of gonadotropins administration and the doses of gonadotropins required, and increases the rate of monoovulations, reducing the risk of cancelled cycles. Metformin co-administration to IVF treatment does not improve pregnancy or live-birth rates but reduces the risk of OHSS. Continue reading >>
How Long Does It Take For Metformin To Work For Conception?
Metformin, also known as Glucophage, is a medication that is used to regulate the levels of glucose (sugar) in the blood. Metformin accomplishes its task through three methods. First, it causes the liver to produce less glucose. Second, metformin helps your stomach to absorb less glucose from the food that you eat. Finally, metformin improves the efficiency of the insulin that the body produces, which reduces the amount of glucose that is in your blood. Metformin is often prescribed for people with Type II diabetes. How long it takes Metformin to work depends on the reason that a woman is taking metformin. If a woman is taking metformin to regulate her blood sugar, metformin typically will work within a few days or a few weeks at the most. For the woman with polycystic ovarian syndrome (PCOS) metformin can help to reduce the amount of insulin in the body. Once the insulin levels are under control, many women will then experience improved ovulation. If metformin is going to work for a woman who has experienced fertility problems because of her polycystic ovarian syndrome, it will typically help within three to six months. Unlike most fertility treatments, metformin does not cause a risk of having a multiple or twin pregnancy. If metformin alone does not help a woman with PCOS who is trying to conceive, a fertility doctor may prescribe Clomid, as well. If metformin is prescribed for a woman with PCOS to help restore a regular, normal menstrual cycle, metformin can work within 4 to 8 weeks. In addition, the stabilized levels of insulin may affect the other hormones in a woman’s body, and reduce other symptoms of PCOS. Some women, either with diabetes or PCOS, use metformin as a tool for weight loss. If this is the case, weight loss can occur somewhere between 1 and 5 wee Continue reading >>
Metformin And Pregnancy: Is This Drug Safe?
Whether you're expecting your first child or expanding your family, a safe and healthy pregnancy is crucial. This is why you take precautions before and during pregnancy to keep your unborn child healthy and reduce the risk of birth defects. In every pregnancy, there’s a 3 to 5 percent risk of having a baby with a birth defect, according to the Organization of Teratology Information Specialist (OTIS). Some birth defects can’t be prevented. But you can lower your child’s risk by taking prenatal vitamins, maintaining a healthy weight, and maintaining a healthy lifestyle. Your doctor might recommend that you don’t take certain medications while pregnant. This is because certain medications can cause birth defects. If you're taking the prescription drug metformin, you might have concerns about how the drug will affect your pregnancy and the health of your unborn child. What Is Metformin? Metformin is an oral medication used to treat type 2 diabetes and polycystic ovary syndrome (PCOS). Type 2 diabetes is a condition that increases blood sugar levels. PCOS is an endocrine disorder that occurs in women of reproductive age. It’s important to maintain a healthy blood sugar level while pregnant. This is one way to reduce the risk of birth defects and complications. Although metformin can control blood sugar, you may question whether this drug is safe to take during pregnancy. Before we get into this, let’s discuss how metformin is beneficial prior to pregnancy. Metformin Before Conception If you took metformin before getting pregnant, you might know that this drug can be a godsend — especially if you’ve had difficulty conceiving. Having PCOS makes it harder to become pregnant. This condition can cause missed or irregular periods, and small cysts can grow on your Continue reading >>
Benefits Of Metformin In Reproductive-age Women
Benefits of Metformin in Reproductive-Age Women Metformin in Reproductive Health, Pregnancy and Gynaecological Cancer: Established and Emerging Indications Sivalingam VN, Myers J, Nicholas S, Balen AH, Crosbie EJ Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality that affects women of reproductive age and can be diagnosed in 5%-10% of them. It is characterized by oligo-ovulation, hyperandrogenism, and polycystic ovaries.[ 1 ] Insulin resistance plays an important role in its etiology. The liver and skeletal muscles are resistant to the actions of insulin, so in order to maintain euglycemia, insulin is overproduced. Insulin and insulin-like growth factor (IGF), however, act as a growth factor in the ovary and stimulate its androgen synthesis. Androgens are then responsible for hirsutism, acne, and arrested follicle development as well. Over 50% of women with PCOS are overweight or obese, which further augments insulin resistance. PCOS is not the only condition accompanied by insulin resistance. Being overweight or obese is also associated with insulin resistance. Insulin resistance, if left untreated, can ultimately result in glucose intolerance and even type 2 diabetes. This review summarizes the known and potential benefits of metformin therapy in reproductive-age women. The benefits of metformin have been extensively studied among infertile women diagnosed with PCOS. The lack of regular ovulation is usually the primary cause of infertility among them. Clomiphene citrate is the typical first-line drug administered to induce follicle growth. Metformin is also frequently prescribed to help ovulation, although randomized trials have not shown superior results when compared with clomiphene. A systematic review found improved ovulation rates with met Continue reading >>
Does Metformin Increase Fertility When You Have Pcos? Last Updated On Jun 04, 2015 By Dr. Renee Hanton, Md
Free Gift! 20 Pregnancy or Ovulation Tests Does Metformin Increase Fertility When you Have PCOS? Many times, doctors will prescribe both Metformin and Clomid, which can increase the chances that ovulation will occur. However, this is not always effective and other combinations are sometimes relied on. PCOS is a common condition that causes anovulation in women. This means that the egg is not released regularly, which makes it difficult for a woman to conceive. Women with this condition develop several tiny cysts on their ovaries that can cause their eggs to not be released. Claim Your 20 Free Pregnancy Tests Click Here While there are many different treatment methods for PCOS, one newer options is an oral medicine called Metformin. This drug is most commonly used to treat diabetes, but it has been shown to be very effective for women with PCOS. Many times, doctors will prescribe both Metformin and Clomid , which can increase the chances that ovulation will occur. However, this is not always effective and other combinations are sometimes relied on. Metformin is also a great option for women who are taking injectable FSH medication because it has been shown to help ease the side effects from these types of drugs. For the most part, Metformin doesnt produce many serious side effects, but some women have discovered that it upsets their stomach. Many women are unsure how to get pregnant with PCOS . While you are taking Metformin, it is suggested that you have intercourse every other day. This will help you to ensure that sperm will be present when the egg is ready to be fertilized. You should also track your ovulation to make sure that you are ovulating as well. Continue reading >>
Polycystic Ovarian Syndrome Fertility Treatment With Metformin (glucophage)
How Metformin Is Used for Polycystic Ovaries Polycystic ovarian syndrome is a common cause of anovulation and infertility in women. These women do not ovulate (release eggs) regularly and therefore have irregular menstrual periods. The ovaries have many small cysts (2-7 mm diameter) called antral follicles, giving the ovaries a characteristic "polycystic" (many cysts) appearance on ultrasound. A relatively new method of treating ovulation problems in women with polycystic ovarian disease is to use an oral medication called metformin (brand name is Glucophage). Metformin has traditionally been used as an oral drug to help control diabetes. Then, some smart doctor figured out that polycystic ovarian syndrome treatment with metformin can be very effective. If Glucophage alone does not result in ovulation and pregnancy, we often use: If the combination therapy is not effective, we can try: Metformin Use with IVF Treatment We also use Glucophage in women going through in vitro fertilization for PCOS, and for those with very high antral follicle counts - if their ovaries are "polycystic" by ultrasound. We find that some women with polycystic ovaries respond with a "smoother" response to the injectable FSH medication if they have been taking Glucophage. Risks and Side Effects of Metformin / Glucophage In about 25% of women Glucophage causes side effects which may include abdominal discomfort, cramping, diarrhea and nausea. The side effects may be severe enough to make the woman stop the Glucophage medication. We are not aware of any serious complications resulting from Glucophage treatment. Another oral medication used for diabetes called Troglitazone has been associated with liver failure and death in rare cases. This has been publicized on television shows, in newspapers, et Continue reading >>
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