The fertility drug metformin (glucophage) first enjoyed widespread use in patients with diabetes because it sensitizes the cells in the pancreas to insulin, thus lowering insulin production to normal levels.
Glucophage (metformin) is being used to treat anovulatory (don’t ovulate) women with polycystic ovarian syndrome (PCOS), a relatively common cause of female infertility. Between 40-70% of women with PCOS will be hyperinsulinemic meaning they have chronically elevated insulin levels.
PCOS patients usually have elevated androgens (male hormones, i.e. testosterone) which are responsible for many of the symptoms of PCOS. Symptoms can include excess body hair (hirsuitism), hyperinsulinemia, increased chance of miscarriage, obesity, classic pear shaped body appearance, and ovaries typically covered with numerous small cysts.
The chronic elevation of insulin leads to the overproduction of androgens and LH by the ovaries ultimately leading to irregular, or failed, ovulation. Hyperinsulinemic patients don’t respond appropriately to a given level of insulin and continually secrete insulin to try and reach the appropriate physiologic “balance”. Thus, a cycle of continuing anovulation is established.
Metformin does not stimulate, or cause, ovulation like other fertility drugs including Clomid and FSH. It establishes a correct physiologic balance by causing insulin production to decrease to normal levels. When this is achieved, the ovaries no longer “over produce” androgens and ovulation will often resume.
Metformin is usually administered at a dose of 500 mg three to four times daily (1500-2000 mg daily). Metformin in combination with Clomid or letrozole has been shown to have substantial improvement in ovulation and higher pregnancy rates compared to Clomid or metformin alone.
For women with PCOS, metformin has been shown to decrease miscarriages, improve pregnancy rates and decrease the risk of gestational diabetes mellitus. Long term benefits of metformin include decrease in the risk of diabetes mellitus, improvement of hyperandrogenism, including hirsutism, and normalizing the menstrual cycle.
OTHER FERTILITY DRUGS
Clomid Fertility Drug to Induce Ovulation
Lupron, Ganirelex Fertility Drugs to Control Ovulation
FSH Fertility Drugs to Stimulate the Ovaries, Puregon, Follistim, Repronex, Menopur