In one recent study of PCOS patients who weren't ovulating, 40 percent of those given 500 milligrams of Metformin two or three times daily ovulated, and of those women, 79 percent became pregnant. The women in the study who didn't conceive on Metformin alone were then also given a low dose of Clomid—a medication to induce ovulation which only has a 11 to 20 percent success rate when used by itself in PCOS patients. But when combined with Metformin, Clomid increased pregnancy rates to 89 percent. Fertilization rates with IVF also appear to be bumped up by as much as 20 percent when women with PCOS are given Metformin a month before ovulation induction.
Some fertility experts also feel Metformin is important in preventing miscarriage—a problem that plagues women with PCOS at three times the normal rate. In a study of women who became pregnant on Metformin and continued taking the drug throughout their pregnancies, the rate of miscarriage was 8.8 percent compared to 41.9 percent in women who stopped taking the drug. Metformin appears, so far, to be safe during pregnancy, although much more research is needed to know for sure. Metformin isn't approved for use as a miscarriage prophylactic—or as an ovulation inducer or treatment for PCOS either. Because it's not FDA-approved for these conditions, some insurers won't cover its cost (about 50 cents per 500 milligram dose).
Long-Term Health Risks
Infertility isn't the only problem posed by PCOS, which is why treating the condition is so important. For instance, PCOS can up the risk of developing endometrial cancer. When a woman doesn’t menstruate regularly, the lining of the uterus doesn't shed; instead, tissue builds up, becoming prone to cancerous changes. A good way for a woman with PCOS to maintain regular periods, once she’s completed her family, is to take oral contraceptives, which have been shown to reduce the risk of endometrial cancer by 50 percent.
There are other health risks associated with PCOS, too. By age 40, up to 40 percent of women with PCOS have either diabetes or its precursor, impaired glucose tolerance. Several recent studies also indicate that women with PCOS may be at two to four times greater risk of developing cardiovascular disease. “It's not just that PCOS patients have other risk factors, like obesity or physical inactivity," says Michael T. Sheehan, MD, an endocrinologist at the Marshfield Clinic-Wausau Center in Wausau, Wisconsin. "PCOS and its characteristic of insulin resistance appears to directly contribute to a woman's diabetes and heart disease risk."
Still, there's plenty of room for hope when it comes to battling PCOS and getting pregnant. For women who proactively manage their PCOS via a good diet, regular exercise, and, in many cases, help from a fertility specialist who understands the latest treatments, the chances of boosting fertility and conceiving are extremely high. What's more, says Dr. Sheehan: "There's every reason to believe you can conquer future health problems like diabetes or heart disease if you stick to your good habits after you're done with child-bearing."
A version of this story originally appeared in the Winter 2005 issue of Conceive Magazine.
Related Topics: Fertility Foods; Fertility Hormones; Fertility Nutrition; Fertility Threats; Infertility and PCOS