Metformin, should I try and get it?

[ntaylor]

Hi all. I've posted about this a few times so I'm sorry if it seems repetitive, but I have my appointment with my RE today and am trying to figure out what I should do. Once again, I have polycystic looking ovaries (which my RE claims is normal and probably good, but I don't really believe as I have long cycles, unpredicatable and 3 miscarriages at 24 years old), no insulin resistance or elevated male hormones. I am also not overweight.
As long as I have no large cyst I'm going to start clomid soon, but should I push for Metformin? WIll it really decrease my chance of miscarriage? I just don't want to have another one. Does it have horrible side effects? WIll it hurt if it turns out I didn't need it at all?
Also, it's a cat B and not considered totally safe for pregnancy use though I know people take it. I just need to consider the risks. Thank you!

[mlb1234]

actually I was shocked when they said I had PCOS.  I did not have any symptoms out of the ordinary except for the long irregular cycles (which I guess is actually screaming out that something is not right in itself!).  I was always on the pill after high school so I never had many other symptoms.  Actually I do ovulate every cycle too - just later than normal like you.  Once we got married in Sept '05 we tried to get pregnant and did right away---ended in m/c.  My OB said to come back after 6 months if nothing happened since I told her how my cycles were irregular.  Well 9 months later I went back after no pregnancies and she sent me to the RE.  They pretty much diagnosed it on the spot via ultrasound and history, they didn't do any blood tests.  I had like 17 follicles on each ovary at that time.  I guess over 70% of women with PCOS have insulin resistance so they just treat for it.  I guess the other 30% don't have insulin resistance but the metformin won't hurt.  I am worried about it tagging me for life insurance wise too but the truth is if you can catch diabetes before it ever happens you may never get it.  I would rather know I am at higher risk and do something about it than ignore it.  I don't think your RE could argue that type 2 diabetes is a huge problem in this country and getting worse.  I figured taking the metformin now could only help things.  I started Met last October, got pregnant in December without anything else (ovulated on day 30 though that cycle) and had another m/c in february.  RE said to wait two cycles to try again.  I said I wanted to be more aggressive and she gave me the option of clomid or femara.  I chose the femara and it worked first cycle last april.  PCOS is a hard thing because it is not a disease, it's a syndrome - it just means you might be at higher risk of getting a disease.  I did have to fill out extra paperwork to increase my life insurance but in the end the insurance company did approve it.  It may be diagnosed too much but there is no test and if you are in baby making mode that is the only thing that matters and most women will do whatever they need to to make it happen!!  ANyways I would, I did and I am so happy now I was aggressive about it.  I think it would be fine for you to start the Met anytime - even right now with the clomid.  Oh one more thing, if you have had 3 m/c's I think your RE should run the clotting factor tests on you.  I am not sure why they haven't done that yet (or maybe they did??)  My RE did it after 2 m/c and recent literature suggests that it is better to test after two m/c's than wait for 3 or more.  My tests did come out normal and now I believe that my m/c's were due to the egg ovulating so late and getting geriatric before fertilitzation but it is an important thing to rule out for miscarriages since the treatment for a clotting disorder is totally different.  Also because I had the m/c's my RE suggested I take one baby aspirin a day and extra folic acid for the first 12 weeks.  I know it sounds like a lot (and it was!!) but here is what I did to cover all the bases:  prenatal vitamin, extra folic acid, 1 baby aspirin, metformin-xr 1500mg/day, femara 5mg days 3-7, prometrium 200mg/day starting 3 days after trigger (to 10 weeks).  At 12 weeks quit the meformin, baby aspirin and folic acid.  Continue with prenatal vitamin throughout pregnancy.  Also just so you know things, don't have to be perfect...I only had one follicle with the femara and I think it was 22mm on day 13 when I got the trigger.  At this time I had no EGCM and I am sure my body actually had no idea what was going on but I still got pregnant.  We bd'd the night of the trigger and the following night.  
I am not sure where you live but I go to a clinic at a big university.  And the person running the clinic was the first in the state to do IVF back in the 80's.  He's an older guy but very experienced and I really like his clinic.  It doesn't hurt to check out other places and find one you really trust.
Oh I just reread you post - we are totally the same.  When I first got AF it was like once a year or every 9 months.  It gradually went down to every three months by the time I was 17y.  Then I started the pill and got it every month (of course due to the pill).  Once I went off the pill 6 years ago it took maybe 3 months to get AF and now my cycle could vary anywhere from 33-54 days.  Very unpredictable but I do get an LH surge and AF two weeks later each cycle!!  WHen I had my day 3 levels (LH, FSH, E2) checked they were totally normal!  I think my brain just has a problem telling whatever to release the LH!!!  I don't know if that is PCOS or what!
Good liuck though - I hope everything works out for you!!!  Sorry for the long post!

[ntaylor]

I just read your last post. I know really! My RE is good, but he has some thing about diagnosing pcos. He thinks it is diagnosed too much in healthy people, which tags them for life for more risk of heart disease, diabetes etc. He says insurance companies take advantage of this, blah blah blah. Each time I ask him about it, he says I do NOT have it. But I'm sure if I went somewhere else they would give me met in a heartbeat. Not only do I have polycystic ovaries, I've had 3 miscarriages and have always had irregular cycles. One year I went 9 months without af. Maybe I should get a second opinion if he doesn't give me a prescription for met today..... Do you think? I'm thrilled he's letting me take clomid, I've been seeing him since jan and this is the first he suggested it.

[ntaylor]

Thank you for your response. How long after starting the metformin did you get pregnant? I should get af thursday and start clomid day 5. If I started met now, would that be ok to try this cycle? I also will take prometrium after ovulating. Right now, I do ovulate each cycle, they just range from 30-45 days, sometimes longer. However, I am able to get pregnant very easily, just not hold it. I'm not sure if that's typical of pcos. Did you have any symptoms of pcos? Or were you never tested for cysts, testosterone or insulin levels? Thanks!

[mlb1234]

p.s if you have polycyctic looking ovaries and a history of long unpredictable cycles, you may want to ask your RE why he/she does not consider that PCOS since you have 2 of the 3 signs for diagnosis.  just a thought...

[mlb1234]

I had no side effects from metformin-xr 1500mg/day.  Just increase the dose gradually.  It didn't bother me at all other than to stop my stomach from growling throughout the day.  It does give some people GI issues though.  They do say it can decrease miscarriage.  It cannot hurt taking it.  It will not give you diabetes or anything like that even if you don't really need it.  Also there is no test for insulin resistance so it is hard to know if you really have it or not.  You do not need to be overweight to have pcos or insulin resistance.  Most category B's are considered safe for pregnancy.  There are very very few category A drugs in existence, only a handful.  I have even heard prenatal vitamins are category B or C.  For your information, clomid is considered category X on Micromedex and it will still be in your system by the time implantation occurs (it has a long half life).  But as you know many women take it and have no problems.  They just don't know if the increased risk of defects is due to infertility itself or the clomid.  Anyways if you feel clomid is safe, you should really think metformin is safe.  
I do not really know if I (or you) "actually" have pcos and I don't know if that matters - I only know that when I took metformin and femara I ovulated on day 13 (earliest EVER), got pregnant on the first cycle and at 19 weeks everything is still OK.  I stopped the Metformin at 12 weeks.  I also took prometrium after ovulation to help support the lining but they never even tested my level - it was just as a precaution.  Regardless of what my problem is/was I plan to try the same thing next time too since it worked perfectly!  Good luck!

[silirama78]

Metformin has helped me i also have PCOS been trying to get pregnant for almost two years and nothing not even clomid has helped but the metformin has helped regulate my weight i had gained 40-50 lbs because of PCOS also i was skipping months on my period and have cysts around my ovaries. I also don't ovulate every month also try asking for Femara that is my next step since clomids is not helping wish u luck and God bless.