Metformin


#1

Are any of you ladies on Metformin in addition to Clomid? I am not with a RE, just getting my Clomid script from my OBGYN, so I am at a little bit of a disadvantage since I’m not with a specialist.

All that to say, I have a friend that told me she has taken Metformin for both her pregnancies and said that otherwise she wouldn’t have gotten pregnant. She said Metformin helps with PCOS. I’ve haven’t been diagnosed with PCOS, but after talking to her, I wonder if an RE would have diagnosed me with it. My OBGYN doesn’t dig too deep, just writes a script, y’know?


#2

Sarah- I too am just with an OB right now. I love her but they have limited expertise with infertility. She’s my only option at the moment since the closest RE is like 2 1-2 hours away. She said we will try 3 iui then she will refer me out. I am willing to do that since right now I am only paying $18 for clomid and $230 for iui with sperm washing. I don’t get monitored though.


#3

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.


#4

ahhny- Thank you so much! That was more than I could have hoped for! I am getting monitored this cycle, it’s up to me and I really want to since it’s my first time doing 100mg. I’m going in for the follicular ultrasound and then the 21CD blood test.

I’m leaning toward trying this cycle with just the 100mg and if I get a BFN, asking about metformin for my next cycle. Or maybe just finding an RE for my next cycle!

I am curious about my thyroid level. I just had my bloodwork done and they said my thyroid levels were normal, but it was an afternoon draw :frowning: so does that discount it?

Thanks again for all that great info! I really would just love for my OB to just give me a script for Metformin next cycle instead of doing all those tests!


#5

[QUOTE=sarahdaisy]I am curious about my thyroid level. I just had my bloodwork done and they said my thyroid levels were normal, but it was an afternoon draw :frowning: so does that discount it?[/QUOTE]

I think that depends on what your number is at the afternoon draw. My first one was an afternoon draw and it was 3.7 I believe. My Doc put me on a low dose of Synthroid because he wanted it to be more ideal for conception which my clinic deems under 2.5. After a month of 25mcg of synthroid I went back for another TSH draw only this time I just happened to do it in the morning. That draw was even higher and in fact clinically hypothyroid at over 5 which really seemed to baffle the RE. He decided to do test my TPO’s and to do a full thyroid panel to see what type of hypoT I was. All else came out good so he just increased my synthroid to 50mcg’s.

However, in talking with another RE (our clinic uses several) I was told that many thyroid issues are missed because the TSH is highest in the morning and lowers as the day goes on so it is possible to have a clinically high TSH in the morning draw and it lower into a normal range by the afternoon and thus the hypothyroid diagnosis is missed. This is what happened in my case. I was really excited though to have discovered this because I have had a bunch of HypoT symptoms for a long time and a strong family history of thyroid/adrenal disorders so they tested me over and over, but never could find anything wrong and suddenly in this instance we discovered that because I always got my draws in the afternoon my diagnosis all these years was just missed. This was wonderful for me because within those two months all the symptoms I had been complaining about for years disappeared and I feel better than I have in a very long time.

Additionally, my TSH came down to 0.7 and I got pregnant that cycle. Then my sister who also has some HypoT symptoms and who had been actively trying to get pregnant for two years without success was telling me how she didn’t have the money or insurance coverage to seek an RE. I shared with her the TSH info I had learned and told her to ask her OB to check it and if it was over 2.5 to ask about getting a low dose of synthroid to try. She did and her TSH came back nearly identical to mine. Her OB was amiable to trying her out on the low dose of synthroid and within a month her TSH was down to a 1. She got pregnant that same cycle and is now nearly 18wks pregnant with a little boy.

So…I think if your afternoon draw is low like around 1 or maybe even 2 then I wouldn’t be concerned with doing another draw, but if your number is over 2 then I would ask for another draw and do it in the morning instead OR if it is over 2.5 then just ask for a low dose of synthroid to bring your level down to a 1 which is considered ideal for trying to conceive. Hopefully your OB will be amiable to it and let you try it and if not then I would go ahead a switch to an RE who will treat you to ideal levels.

:cross: your afternoon draw is nice and low though and you can just move forward with the clomid and CD 21 P4 draw