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PCOS patients are hyperinsulinemic meaning they have abnormally elevated levels of insulin. Metformin increases the pancreatic cells sensitivity to insulin thus lowering insulin levels and reversing hyperinsulinemia. The hyperinsulinemic state in PCOS patients leads to increased insulin production and increased androgen (male hormones) production. Androgens are male hormones similar to testosterone. Most of the clinical findings of PCOS are due to elevated androgens and include dark body and facial hair, sometimes male pattern baldness, pear shaped body appearance, numerous unruptured cysts on the ovaries, and other symptoms. Continued untreated, PCOS patients can have serious future health risks such as cardiovascular disease, and diabetes. Since metformin sensitizes the cells to insulin, less insulin is needed per measure of carbohydrate. Once insulin levels decline overproduction of androgens by the ovary usually diminishes allowing normal ovulation to resume. Metformin is not an ovulation induction medication; rather it returns the hormonal milieu to normal allowing normal ovulation to resume. Fertility specialists will often continue metformin therapy to help avoid future negative health consequences. If metformin alone is insufficient, Clomid can be added. Additionally, metformin can be administered with FSH for ovulation induction. PCOS patients often have exaggerated responses to FSH which can exacerbate after the injection of hCG and become serious as in hyperstimulation syndrome. For this reason, only a board certified reproductive endocrinologist, infertility specialist with extensive clinical experience should manage these patients. Fertility DrugsSite Index |
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