Metformin is effective as a treatment for anovulatory infertility amongst women with PCOS. A Cochrane review of seven RCTs involving 702 women found that the clinical pregnancy rate for metformin versus placebo was significantly increased [Peto odds ratio (OR) 2.31, 95% confidence interval (CI), 1.52 to 3.51] (10).
The benefit of metformin on ovulation in women with polycystic ovaries is not seen right away. There is some benefit starting about a month after beginning metformin. Metformin has a more substantial benefit for fertility when the woman has been taking it for at least 60 to 90 days.
Metformin for PCOS is generally recommended for decreasing weight and also reducing the risk of developing gestational diabetes mellitus. It may also be effective in treating anovulatory infertility in non-obese people with PCOS.
The chances of becoming pregnant increased by 98% after metformin treatment. The chance of a live birth rate (LBR) increased by 59% following metformin treatment. While the LBR following a placebo was 19%, it was between 19 and 37% after metformin. The chance of ovulation increased 2.64 times with metformin treatment.
Even though metformin may lead to some weight loss, the amount you lose may be far less than expected. On average, weight loss after one year on the drug is only six pounds, according to past research.
In various clinical studies, when metformin was used alone, it led to a weight loss of 0.7 to 3.8 kg (1.5 to 8.4 lbs) in patients. Many clinicians consider metformin a "weight neutral" treatment, meaning it does not cause a significant amount of weight gain or loss.
The main side effects associated with metformin treatment are the gastrointestinal symptoms of nausea, diarrhoea, flatulence, bloating, anorexia, metallic taste and abdominal pain. These symptoms occur with variable degrees in patients and in most cases resolve spontaneously.
In contrast, metformin is a drug that affects metabolism and acts indirectly to induce ovulation by reducing the circulating concentration of insulin.
A medical provider can run a few tests to see how metformin is affecting your health: Blood work can check if your glucose, insulin, and HbA1C levels are in range. If they are, the medication is working.
As much as possible, avoid white bread, white rice, white pasta, candy, soda, desserts, and snacks like chips or crackers. Eating foods that can spike your blood sugar will not necessarily make the metformin not work, however, it will increase the burden it has to work against.
Metformin is an effective ovulation induction agent for non-obese women with PCOS and offers some advantages over other first line treatments for anovulatory infertility such as clomiphene. For clomiphene-resistant women, metformin alone or in combination with clomiphene is an effective next step.
Metformin can be taken long-term for PCOS. Some patients take it for weeks or months to get symptoms under control, while others use it long term to maintain health.
Improve Pregnancy Rate: Doctors accept that a combination of Metformin with other fertility drugs improves the pregnancy rates. Injectable gonadotropins combined with Metformin can boost the birth rate up to 32-60% in women.
Metformin is a drug used to treat insulin resistance. When used in women with PCOS, about 40% will begin to ovulate in the first 6 months of treatment. Clomid is a more effective drug for ovulation, but metformin in combination with clomid can help some women ovulate who didn't respond to clomid by itself.
The PCOS belly involves the accumulation of visceral fat in the lower abdomen and typically feels firm to the touch. A PCOS belly is also characterized by a high waist-to-hip ratio of greater than 0.87 (apple body shape). However, some individuals may not experience any noticeable changes in their stomach.
You're not losing weight or you've gained weight
However, if you're eating healthy and exercising regularly in conjunction with taking Metformin, but your weight hasn't budged or you've gained weight, this could be a sign that you may need to increase your dose or seek an alternative.
Metformin may also reduce weight by decreasing the amount of visceral fat in the liver and muscle tissue. Visceral fat is stored within the abdominal cavity, which contains several internal organs, including the liver, stomach, and intestines.
The use of metformin by non-diabetics stems from some evidence that metformin can decrease inflammation, protect against cardiovascular disease and cognitive impairment, minimize cancer risk and progression, and prolong life.
Metformin has been shown to improve fertility outcomes in females with insulin resistance associated with polycystic ovary syndrome (PCOS) and in obese males with reduced fertility.
Increased ovulation and pregnancy rates have been observed in PCOS, with or without hyperinsulinemia, after metformin (12) from 2 weeks of therapy on (13) without high-order pregnancy. An observational study (14) reported three twins out of 81 gestations (3.7%) with metformin only.
Metformin and fertility
There's no evidence to suggest that taking metformin reduces fertility in either men or women. Metformin is sometimes prescribed to try to improve ovulation and fertility if you have polycystic ovary syndrome (PCOS). Having a healthy body weight is important both for fertility and for pregnancy.
If you have infertility issues with PCOS, your doctor may prescribe medications to help regulate ovulation. These include Clomid (clomiphene citrate), Femara (letrozole), and Glucophage (metformin). Gonadotropins, which are hormone injections, may also be an option for stimulating the growth of an egg follicle.
What is Metformin? Metformin is a drug that is used in women's health for polycystic ovarian syndrome (PCOS), problems with excessive facial hair (hirsutism) and is also used for diabetes.
Unexplained increases in blood sugar may be the first sign that metformin has stopped working. You may also experience symptoms of hyperglycemia such as excessive thirst or hunger, fatigue, and blurry vision.