Clomid, Metformin or both?

[tantylynn]

I was diagnosed with PCOS a few weeks ago and I've been doing research in preparation for my visit to the fertility specialist in May. It seems that the first stage of treatment is generally either Clomid or Metformin, or a combination of the two.

Anyone have an opinion as to which works best?

I keep thinking that I should just trust whatever the doctor recommends, but after all of the horror stories I've read of doctors who didn't have a clue I wanted to go into the appointment with some research and ideas of my own.

Any advice/help/experiences would be greatly appreciated!

Thanks!

[jlbanana]

Hi Tantylynn - I was diagnosed with PCOS in college.  That being said, 9 months after I got married, after a one-time "mistake" I conceived our first child.  Really shocking!  I had a lot more trouble (6+ months of trying) conceiving our second, but never did the traditional fertility drugs or anything.

Have you tried charting your cycles?  Before you go to a fertility specialist you should at least get educated and know if there's any regularity to your cycles, if you have signs of ovulation, etc.  If you haven't seen it, check out the book "Taking Charge of Your Fertility."  

I found that by charting I was able to know what was going on and alter my lifestyle to make me more likely to conceive.  Exercise seemed to be the primary thing affecting me - the more regular aerobic exercise I got, the more "normal" my cycles were.  I also cut some chemicals out of my personal products and started using shampoo/conditioner/lotion/soap etc. from "natural" companies found at Whole Foods and the like. I honestly think that helped.  

[tantylynn]

Thank you for your response jlbanana! It's always good to hear from people who were able to conceive with PCOS!

I have been charting this cycle, and over the 2 years we've been TTC I kept track of my cycle dates. They are irregular, ranging from 26 to 69 days, with an average of 35-45 days. My doctor tried to see if I ovulated last cycle with blood work, but missed the peak. We're trying to catch it this cycle, but FF seems to think I already ovulated (if in fact I ovulated). It's a bit all over the place at the moment!

Weight gain is actually the one symptom of PCOS I don't have, so unfortunately losing weight is not an option for me to make pregnancy more likely. DH and I are both fit and healthy and have made an effort to be even more so since TTC. We have made a lot of changes over the last 2 years. Since we are both young, and thus felt there should be no problem in getting PG (if only, right?), we decided it was time to seek help from a fertility specialist.

While I am still interested in natural ways to promote fertility, I am really looking for more information related to fertility drugs and treatments. Unfortunately at this point, it is the next step for us.

Thanks again! Congratulations on your two joys

[monkeyscience]

I have heard from a lot of friends that Metformin alone was enough to get them to conceive, but I think most of them were battling at least some weight issues/insulin resistance. I've done a couple of different tests to see if I have IR (I'm also normal-weight with PCOS), and they've come back negative. My RE says that, for that reason, he doesn't think Metformin will help me. I'm a little dubious, because I'm pretty sure I remember reading a study that said that Metformin seemed to help women ovulate even in the absence of IR. Also, studies have DEFINITELY shown that Clomid is more effective for PCOS when combined with Metformin, but I don't know if they looked at the difference between insulin-resistant and non-insulin resistant women.

I'll also say that, personally, I couldn't handle more than 500 mg of Metformin a day, which is a low dose. It supposedly doesn't affect your blood sugar levels if you're not insulin resistant, but when I started taking it twice a day, I woke up with a headache every morning and experienced severe nausea. (I never did get the diarrhea that's supposedly the hallmark of Metformin.)

I will see if I can dig up the studies I read.

[monkeyscience]

Not having luck finding articles right now, but you can also check out www.soulcysters.net for lots of great PCOS information - assuming the site isn't down. (It's down/slow a lot for me. :()

[tantylynn]

Thanks for the information! Is this the study you read? http://eje-online.org/cgi/content/full/157/5/669 That's what got me thinking that even though I don't have a weight issue and may not be IR (haven't been tested for that yet), it would still be worth a shot! I'm also a member over at soulcysters but I honestly haven't spent much time there. I find it a little difficult to navigate.

So obviously your RE gave you Metformin despite his reservations...what did he end up prescribing you? Metformin and Clomid?

[monkeyscience]

Yeah, I think that was the study. And I, too, find SoulCysters difficult to navigate, sadly.

No, the RE actually didn't give me Metformin. I actually got that from my OB/GYN about a year ago. Sorry to muddle things! My RE is giving me letrezole (Femara) and dexamethasone (to suppress testosterone production.)

[tantylynn]

Oh ok, I'll have to do some research on dexamethasone, that's one I haven't heard of lol. The nurse at an appointment I had today talked to me about letrozole vs clomid. She said that here in Australia it hasn't been endorsed by the government yet as a drug to treat infertility, so while it is available and the doctors do stand by it working very well (with much less effect on the lining than clomid apparently) it costs about 3x as much as Clomid...I think she said about $60 per cycle. Hmm..

Thank you so much for sharing your information and your experiences with me! I hope that the treatment you are on now is successful!

[monkeyscience]

Yeah, letrezole isn't approved for fertility here, either. (I actually think it isn't approved anywhere, as the company doesn't want it to be due to liability risks. I know that Yale is doing a clinical trial of letrezole vs. clomid, though!)

I think the only place I've really heard about the dexamethasone is here, and that's not about using it specifically for fertility, but I do think it explains the basic logic behind it. It's super long, so you might want to use your browser's search function to find the dexamethasone part!