PCOS, Polycystic Ovarian Disease

Polycystic ovarian syndrome (PCOS) is a common cause of infertility in women. It is characterized by anovulation (lack of ovulation) or oligoovulation (irregular ovulation), ovaries containing numerous cysts, insulin resistance and symptoms of elevated androgens (male hormones). These symptoms can include excess facial hair growth, thinning of head hair, elevated cholesterol levels, and difficulty loosing weight.

PCOS patients are usually hyperinsulinemic, which means they have elevated insulin levels. Insulin is secreted by the pancreas and normally causes a decrease in glucose levels. In the PCOS patient, for a given amount of insulin the reduction in glucose levels is less than in a normal patient. The body produces more insulin (hyperinsulinemia) to account for this reduced response. The high levels of insulin cause an overproduction of androgens and increase the long-term risks of coronary and vascular diseases. Elevated levels of androgens also interfere with normal ovulation in PCOS patients.

Oftentimes metformin is used by reproductive specialists as a “first line” therapy or in patients who fail Clomid therapy. Metformin is sometimes used in combination with either Clomid or FSH. PCOS patients often have an exaggerated response to FSH medications and must be monitored by a fertility specialist

Metformin sensitizes the cells to insulin thus lowering the body’s production of insulin and consequently reducing androgen production. Once androgen production has been normalized, ovulation often resumes. Metformin is dosed at 850 mg. two times per day or as instructed by the physician. Clomid or FSH may be added if ovulation is not established. The major side effects of metformin are stomach aches and loose stools.

Many infertility specialists prescribe metformin for long term maintenance in PCOS patients. Normalization of insulin levels over time will reduce the risk of medical conditions such as cardiovascular disease.