PCOS Treatment: Clomid, Provera & Pregnancy Concerns

Question
i suffer from pcos.  i am on 1000mg metformin for insulin resistance. i have not ovulated since being on the metformin, so i was prescribed 10mg provera for 5 days.  after getting the progesterone withdrawal bleed i am to start on clomid - 25mg on days 2-10. i have just finished the course of provera, but on day 5 of the treatment, i did get mucous indicating that i could have ovulated.  if i did fall pregnant, would the provera harm the fetus - keeping in mind that it has not implanted.   can the provera prevent implantation?

Answer
Hello Michelle from South Africa,

My first recommendation to you would be to change doctors and find a fertility specialist.  I am leery about the doc treating you currently because the treatment methods are not proper.  In answer to your question, provera will not prevent implantation and will not harm the fetus.

If you have been given the diagnosis of PCOD and have been found to be insulin resistant, not just put on metformin because you have PCOD, then the treatment of choice is Metformin with ovulation induction.  The proper metformin dose in this case is a minimum of 1500 mg per day.  Clomid is then used from 50mg-250mg per day on cycle day#3-7 or 5-9 (only five days).  Most PCOD patients will not respond to low dose Clomid so I usually will start at 150 mg per day and increase from there.  The majority of Clomid patients will not respond to high dose Clomid and will need to move to stronger medications but one does not know this until you try.  In order to not waste too much time, I will use 150mg and if that does not work then use 250mg in the next cycle.  Then if that does not work, I move on  to stronger injectable medications.  I refer you to my blog where I have written extensively about PCOS and Clomid ovulation induction.

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 follow me on Facebook at http://bit.ly/9Iw9oV