QuestionDear Doctor,
I have been reading your blog, and I have a specific question so am writing to you. I am a 27 yr old female,(140 lbs and normal BMI of 23) diagnosed with PCOS. My husband and I have been trying to conceive for the last 1 yr. I was on Metformin HCL 850mg twice a day for 6-7 months. I had an ovarian cyst that was pretty large, and I underwent a laproscopic procedure to get it removed and also a D&C a month back. Since Metformin 850* 2 was too much for my weight and I had several side effects like diarrhoea, I was switched to Glucophage 500mg twice a day.
At this point, should I continue trying to conceive just with this medicine, or start consulting a fertility specialist to start using Clomid or something (that is next step). Should we continue trying for 3-4 months after the D&C before we go on to next step.
Thank you so much..
Mer
USA
AnswerHello Mer from the U.S.,
The usual dose of Metformin (glucophage) is 500 mg three times per day for a total daily dose of 1500 mg. This is the minimum dosage that has been found to be effective for the treatment of hyperinsulinemia in PCOS. Less than that is probably not effect. Glucophage has multiple side effects so is usually given at the lowest dose and increased to the effective dose over several weeks. That is, we start at 500 mg per day for 1-2 weeks, then increase to twice per day for two weeks then increase to three times per day. This methods allows your body to get used to it and minimizes the side effects.
However, based on your history of wanting to get pregnant, you absolutely need to go see a fertility specialist so that you get the appropriate evaluation done and the appropriate treatment. Otherwise, you will be wasting a lot of time and money. Don't assume that PCOS is the only reason why your are not getting pregnant. Your body has to go through 9 steps to achieve pregnancy and so there are 9 places where problems could occur.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
