16 Responses to “IVF and PCOS: The Role of Metformin Therapy”

1. C. says:

   December 22, 2009 at 5:25 am

   Dr. Sher,
   Do you advise your PCOS patients who have conceived via IVF to continue their metformin therapy during pregnancy? If so, for how long – just the first trimester or throughout the pregnancy?

   Many thanks
   Catherine

   Reply
2. Geoffrey Sher, MD says:

   February 13, 2010 at 10:25 pm

   The decision is to be made on an individual basis by and with your OB.However, it would not harm the baby.

   Geoff Sher

   Reply
3. carla says:

   October 25, 2012 at 9:45 am

   Do you know if metformin delays your AF? I started it 4 weeks ago & STILL waiting for AF. I have PCOS and irregular periods (usually about every 40 days) im now at about 52 days. is this because of the metformin?

   Reply
   • Geoffrey Sher says:

     October 25, 2012 at 2:30 pm

     This should not be the result of Metformin.

     Geoff Sher

     Reply
4. Rebecca says:

   November 6, 2012 at 2:53 pm

   Is it possible to use fertility pills when you don’t have regular periods. Is it possible to take Provera to start it and then another medication to use to try to conceive? I’m looking for cost what is cheaper meds or IUI if you have PCOS.

   Reply
   • Geoffrey Sher says:

     November 6, 2012 at 5:11 pm

     It is plausible, but discuss with your doctor.

     Good luck!

     Geoff Sher

     Reply
5. mel says:

   January 6, 2013 at 9:05 am

   Dr Sher,

   I recently learned of an alternative med/supplement for women with PCOS called Pregnitude (brand name USA) or INOFOLIC (Europe) consisiting of folic acid and myo-inositol

   Could you please give your opinion on the success of this treatment as opposed to metformin to improve egg quality?

   Thank you

   Reply
   • Geoffrey Sher says:

     January 6, 2013 at 9:37 am

     Folic acid is one of the few known supplements that improve egg development and quality. Myo inositol mightbenefit people with PCOS. Insulin resistance has a key role in the pathophysiology of polycystic ovary syndrome PCOS. Jnsulin resistance and hyperinsulinemia, possibly because of a deficiency of a inositol-containing phosphoglycan that mediates the action of insulin may play a key role in the pathogenesis of PCOS. Administration of myo-inositol might replenish stores of the mediator and improve insulin sensitivity in patients with the polycystic ovary syndrome (PCOS), thereby improving ovulatory function and decreasing serum male hormone (androgen) concentrations, blood pressure, plasma triglyceride concentrations and thereby help ameliorate some of the metabolic and physical manifestations of this condition.

     More than 18 trials have specifically examined the effects of these drugs on ovulation, and other features of altered metabolism in PCOS. Most of these studies reported have not been randomized but the results appear to be quite promising. It would seem that D-chiro-inositol may improve the potential for ovulatory cycles in patients with PCOS.

     Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

     1. “The use of Nutritional Supplements in IVF”

     2. “Polycystic Ovarian syndrone (PCOS)”.

     3. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

     4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

     5.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

     6. “IVF success: Factors that influence outcome”

     Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

     Geoff Sher

     Reply
6. mel says:

   January 7, 2013 at 8:36 am

   Thank you very much for your insight.

   Reply
   • Geoffrey Sher says:

     January 7, 2013 at 5:53 pm

     You are most welcxome.

     Geoff Sher

     Reply
7. Kelly Belmont says:

   February 22, 2013 at 9:42 am

   Dr Sher,

   I have recently learned of your clinics and been reading several of your blogs and thought to email you some questions. I am curious if I give you a brief case history on myself if you could let me know if you think my current RE is missing some additional testing that we should do. Both my husband and I are 32. We have been trying for 5-6 years and have sought help in the last 2 years. Money is tight so treatments are spread out. I have been diagnosed with mild PCOS (based on ultrasound only…due to the string of pearls look) My day 3 labs were normal (though I don’t think they did the AMH, or Inhibin B), Thyroid normal, male hormones normal, and HA1C was normal. HSG=normal and Laparoscopy done in 2004 was normal. My husband has had several analysis and each time comes back fine as far as count, motility, and morphology) The first time it came back abnormal (2008) but every time after that he has been fine. I am not sure if other testing was done regarding his specimen. Should I ask for more in depth testing on him? Unmedicated:My cycles are abnormal ranging from 32-60 days at a time. Sometimes I ovulate and sometimes not. However, there are many times I have ovulated naturally and timed intercourse accordingly and still no success. Since being on Metformin, my cycles are usually 30-35 days and I do see ovulation through BBT, but not much mucus as of recent cycles (though we use Preseed) and still no success with timed intercourse.

   My BMI is 25.5-26 so about 8-10 lbs overweight. I am on metformin 1500mg. I did have 1 natural conception but sadly I had a missed miscarriage around 16 weeks, and delivered my son’s body around 19 weeks. We did no testing, as it was our first miscarriage we were told it was normal to have a miscarriage at least once. This was in 2010, 3 years into trying with BBT, LH kits, Mucus Checking. Since that loss we have done clomid, clomid and IUI, and two FSH/Ovidrel/IUI cycles. Each FSH cycle. I just finished my second FSH/IUI cycle. I had (1) 17.5 Follicle and (2) 14 follicles, and several smaller ones the morning of trigger. my lining was 10mm and E2 was 481. My husbands sperm was 86 million and 76% motile on IUI#1 (12 hours after ovidrel) and 80 million and 92% motile on IUI #2 (35 hours after ovidrel). I can’t help but think we are missing something else and that is why I am wondering your thoughts. They did not follow up with ultrasound after to make sure I did ovulate as they said this method is futile. They said even with these parameters it was just “bad luck” Do you think we are missing some testing here? I really don’t know where to go from here. I just question if mild PCOS is truly the only problem. I respond well to the medications and if all the parameters look good, I don’t know what else to think as to why it is failing. I am getting very discouraged and just spent a lot of money on a failed adoption, so my resources are low. I need to be very smart in next steps. So, The only thing I am thinking about is maybe antisperm antibodies (what do you advise to find this out or what treatment do you think); Could Mild PCOS with no known blood work issues still have Too hard of an egg shell to penetrate and is there testing for this, or is something stopping an embryo from implanting, though my son who was a Missed miscarried implanted and I had to take medication to force the miscarriage to happen 3 weeks after his demise, so I feel that my uterus accepted him just fine. (Regarding the NK cells, do you think then that that would NOT be my case since I did get pregnant and last to 16 weeks) And FYI: I mentioned your article to my RE’s nurses and they don’t believe in the NK cells affecting anything BUT I Found your article on that quite interesting and to me it made sense. I know this was long, but I can’t imagine you giving me any accurate feedback without you knowing the background. Thank you for taking the time to read this and respond. It is much appreciated.

   Thank you very much,
   Kelly

   Reply
   • Geoffrey Sher says:

     February 22, 2013 at 3:18 pm

     Two issues jump out at me. The first is that your PCOS might be affecting egg quality and that you might need a very individualized gonadotropin driven- stimulation. The second (an even more likely) is that you have an autoimmune or alloimmune implantation dysfunction (see below). You case is more suggestive of an Alloimmune issue to me but this would take careful assessment. I sense your responsible attempt to move cautiously but bear in mind that cost comes in two packages. The first is the financial considerations, and here it is not the cost of one procedure over the other that matters. Rather it is the financial cost of having a baby. The second is the emotional cost and this is often even harder to endure.

     I urge you to contact Reprosource in Boston and to ask that they test your blood for natural killer cell activity using the K-562 Target cell test.Then send me your old records (all of them) and call 800-780-7437 or 702-699-7437 to arrange for us to have a telephone or Skype consultation .

     In the interim, go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

     1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

     2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”

     3. “Agonist/Antagonist Conversion Protocol”

     4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

     5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

     6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

     7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

     8. “PCOS”

     Sincerely,

     Geoff Sher

     Reply
8. Kelly Belmont says:

   February 25, 2013 at 6:48 am

   Dear Dr Sher,

   Thank you for your response. I have been reading several of the articles you have referred me to…thank you. It has been a big help in understanding some more things.

   I am putting a call into my primary RE and seeing if he will order the tests so that I will have all those results to offer you when I send my records your way. However, as I have mentioned, my clinic may not believe in testing for NKa stuff, so I am curious is this something that I would be able to have you order before or after our first consult by skpe? I have not yet set up an appointment, but I definitely plan to do so once I figure this out with my current RE.

   Would you please clarify something for me. Do I only need to test for the K-562 Target Cell test….and Only if that comes back positive then I would need to test for the DQa and HLA or other immune issues?

   Thank you again for your help. I look forward to working with you in the very near future!

   Blessings,

   Kelly

   Reply
   • Geoffrey Sher says:

     February 25, 2013 at 8:05 am

     You could start with the K-562 test and if that is borderline or positive, we would go further. I can order this for you once we have done the Skype consultation.

     Geoff Sher

     Reply
9. Kelly Belmont says:

   February 25, 2013 at 9:34 am

   Dr Sher,

   Thank you very much! I will be on the phone to schedule a consultation as soon as possible!!!

   Take Care,

   Kelly

   Reply
   • Geoffrey Sher says:

     February 25, 2013 at 8:08 pm

     I look forward to meeting you. Try and set it up via Skype.

     Geoff Sher

     Reply