Yes Metformin does help with pcos for multiple reasons. However, as far as helping with ovulation it only works for 30% of those who take it alone so it often used in conjunction with clomid to increase the odds of maturing follicles and ovulation.
Some RE’s even use it in patients that aren’t diagnosed with PCOS because there is some thought that it can help even in those patients.
What is important to know about Metformin is that IF you do have pcos then you odds of miscarriage increase to 30% because the cysts on the ovaries hold testosterone which overrides other hormones such as progesterone which is vital to sustaining the luteal phase of the cycle (later half after ovulation) and to sustain a pregnancy should one occur. So being on Metformin reduces the risk of miscarriage while also protecting the ovaries from over stimming (since often they stim differently than those without pcos). It also helps protect the ovaries from more cysts holding testosterone and from the insulin resisting hormones that is often an issue in those with pcos. So there are lots of good reasons to take it especially if you think you may have pcos.
Okay so…you may want to ask your OB about running a thyroid panel to make sure your TSH is under a 2.5 (at a morning draw) as that is necessary for getting pregnant with a 1 being ideal. Some will even allow you to take a low dose of synthroid even if your levels are not clinically abnormal just to bring it down to more ideal levels for conceiving.
You will also want to ask your OB about checking for hormone levels that are indicative of PCOS such as elevated testosterone, low DHEA’s, low progesterone, and low estrogen as well as potentially a pre-diabetic A1C. If these levels come out as described and/or they see a polycystic appearance on ultrasound then they can easily make that diagnosis. However, your OB may be amiable to just putting you on the Metformin to try it out without doing all this for the pcos diagnosis.
While you are at it though also have your OB check your prolactin levels as sometimes that too can be slightly elevated and hinder conception and like the less than ideal TSH is an easy fix with a low dose of Bromocriptine.
It doesn’t hurt to have these tests done as if all the results come back fine then at least you know those aren’t hindering your efforts and if they come back less than ideal then you can make them more ideal with a little medicine in addition to your clomid.
Some OB’s though don’t want to do any of this and just throw clomid at you hoping you will get lucky. This is clearly a huge drawback if your situation turns out to be more complicated so in this case I would not recommend staying with the OB and trying just the clomid longer than 6 ovulatory cycles.
Also, if your OB doesn’t monitor at least ask them to do a CD 21 progesterone draw so that you can see if the clomid even worked to produce ovulation and if your progesterone is good enough to sustain the luteal phase and pregnancy should it occur. This way you aren’t flying so blind.
If your OB refuses you may be interested in doing any of these on your own dime at mymedlab.com. This is a website put together by Docs so that patients could order their own tests to advocate for their own health. Some of the tests are not all that expensive especially if you order more than one at a time, but if your Doc won’t do a TSH draw or a Progesterone then I would definitely consider putting out the extra money to order them yourself. I have used this before with great success. It is so easy as all you do in put the test you want in your cart and then buy it and have one of their Docs put in the order for you. Then you print out the order (which is usually available as soon as you buy it) and take it to a local participating lab. You have your results within a couple days usually.
But if you do a TSH and yours is under 2.5 then you are good. If it is higher then you can take it to your Doc and ask them about it. If you do your CD 21 progesterone then if it is over 15 then you ovulated and that is good to know when taking the clomid because then you know it is working to induce ovulation at least. If it is under 15 then take it to your OB and ask about it. It may be that you need a higher clomid dose or if you are already on the highest dose then you know it isn’t working for you and you need to switch to a specialist.
I hope I haven’t confused you too much. :flower:
If all else fails and after 6 months or 6 decent ovulatory cycles with your OB it is time to move to a specialist as staying too long with your OB will just waste your time. Hopefully your situation isn’t all that complicated though and you have success with your OB.
This is just my advice based on my own experience starting out with my OB.