Posted on:August 25, 2015
metformin (Glucophage, Fortamet, Glumetza)
In certain medical conditions such as polycystic ovarian syndrome (PCOS), metformin may provide a useful addition to other fertility treatments. Women with PCOS often demonstrate increased production of insulin to maintain normal blood sugar (glucose) levels—this is one definition of ‘insulin resistance.’ Additionally, PCOS patients are at risk for developing diabetes mellitus, and this may even occur while they are in their reproductive years.
The best available evidence among women in the United States with PCOS not only demonstrates that administration of metformin results in significantly lower pregnancy rates than those observed with Clomid, but also that the combination of these two medications may or may not produce higher pregnancy rates than Clomid alone (Legro RS et al, New England Journal of Medicine, February 2007). Keep in mind that this well-designed research and other smaller studies supporting these findings are more indicative of results among a population of PCOS patients rather than individuals with the disorder. Therefore, we recommend blood testing for disorders of glucose metabolism (including diabetes) followed by tailoring the decision of whether or not to add/continue metformin to your individual clinical situation.
human chorionic gonadotropin or hCG (Ovidrel, Novarel)
When ultrasound measurements and/or hormone testing are indicative of mature follicles during a stimulation, we will instruct you to take hCG, more commonly known as the ‘pregnancy hormone,’ in order to simulate an LH surge followed by maturation/release of the egg(s) residing within the follicle(s).
Keep in mind that the egg and sperm typically unite in the last third of the fallopian tube and that the average time of ovulation is between 38 and 39 hours after hCG administration. Therefore, ovulation induction cycles in conjunction with intercourse or intrauterine insemination allow for more flexible hCG timing (24 to 48 hours before introduction of sperm) in comparison with IVF cycles (35 to 37 hours before egg retrieval).