Metformin and borderline PCOS

sarcasticowl

Hi everyone. At our WTF appointment at the end of November, my RE decided to start me on Metformin because my AMH levels (back in JANUARY) indicated I might have PCOS. Mind you, my level was 5.91 (I was 37 at the time, just turned 38) and anything over 5 is considered a "diagnostic criterion for PCOS" but usually in conjunction with other tests.

Despite all the many tests and ultrasounds I have had in the past year, including when I wasn't on any hormones, no one ever told me I had reason to worry about PCOS. They did not mention multitudes of cysts. I didn't hyperstimulate during my retrieval cycle. When not on meds, I seem to ovulate at the same time every month (via LH test strips and CM observation) and my periods are the same length each month. Other than being overweight (which is due primarily to being mostly sedentary and working in an office, not to mention my affinity for food that's horrible for me) I don't have any of the classic symptoms of PCOS (hirsutism, acne, hair loss).

So I went on Metformin ER - 500 mg. once per day for a week, then moved up to 1000 mg. (always taking them with food) and I have been SO SICK. Anything I eat comes right out of me (sorry TMI) and I am constantly hungry because my intestines are clearly unable to derive actual nutrients from my food before violently expelling it.

My question is: Is Metformin really going to make or break my FETs going forward, does anyone know? I have 9 embryos on ice and I'm not planning on doing another retrieval in the near future and hopefully not ever again. I would almost rather end up childless than feel nauseated and have diarrhea every day all day, which for me is saying a lot, but it's complete torture.

mtpbadger

Hi @sarcasticowl my RE put me on metformin as a "last resort" for FET to see if it would help with my lining. My ovaries are classic PCOS and I don't ovulate ever on my own, but no other symptoms (I'm on the thin side, no insulin issues). The GI issues do tend to level off after a few weeks as your body gets used to the meds, so hang in there!

****TW**** I was on it for 4 months and did a FET in October. Had my best lining to date (had several failed transfers and several canceled due to thin lining) and one of the two we transferred stuck and I'll be 12 weeks on Wednesday.

sarcasticowl

@mtpbadger That is awesome!!

bethann1022

@sarcasticowl I was started on metformin for PCOS about five years ago, and it made me so sick I couldn't tolerate it.  Then about two years ago, a new endocrinologist started me on the Extended Release and I have had no GI symptoms except mild nausea if I take it before 6pm.  I usually take 2000mg ER with dinner and have no problems tolerating.  Maybe ask your doctor to prescribe the Extended Release one?

AngryBull

@sarcasticowl when I started with my RE the first thing he did was put me on Metformin (and inositol supplements). At the time I was 36 and my AMH was just under 5. He didn't even wait for any other blood work or tests - he took one look at the AMH number and, given my age, said it was one of the best courses of action for me. (Other than the high AMH the only other "classic" PCOS symptom I have is the pearl-like strings of follicles/cysts when looking at my ovaries on US.) 

While I haven't had success (yet) personally I would suggest sticking with it. I've seen it make a big difference for other women with PCOS symptoms on these boards and in some of my support groups. I had the exact same symptoms you're describing (I did 750 mg for 1 week then 1500 mg a day since). It took my body months to adjust (sorry) but when I finally did I noticed a big difference - more regular periods, confirmed ovulation almost every month, fewer sugar cravings, etc.

Also, before I was on Metformin I thought I was ovulating regularly. I turned a digital ovulation test every month like clockwork. But my RE explained to me that women with PCOS really shouldn't rely on those tests. If you have PCOS you often have high baseline LH levels to begin with and can turn the tests easily (most of the websites for the tests say something like this but I'd never read them). My doc actually had me come in every month for 6 months after I would get a positive on the test (like a week or so later) and would test for ovulation. It turned out I'd only ovulated 3 of the 6 times. But after I started on the Metformin the same testing indicated I'd ovulated 5 of 6 times we tested.

I'm sorry you feel so bad. IF really stinks - and Metformin isn't easy (honestly, I thought it was harder than the IVF retrieval itself). I hope you come to a decision that is right for you. 

sarcasticowl

@bethann1022 This is the extended release version unfortunately. I have a VERY sensitive stomach. @AngryBull I'm glad to hear that it does eventually not make you feel like death. It's really good to know that you've heard people who've had success with it, too. It makes me nuts thinking that I could have started on Metformin a year ago but no one either noticed or thought it was important. Grrrrr.

Irisheyes81

I have PCOS non insulin resistant. Did they test your testosterone level? Metformin helps with that. It’s the wonder drug for fertility with PCOS. It helps remove advanced glycation end products, even in non insulin resistant people. See what your fsh/lh ratio is. High LH and testosterone is terrible for egg quality. I started it in December 2016 and felt terrible. The best dose is 750. Don’t let them give you more. I had a crappy RE that put me on 2500 mg. Yuck. You’ll get used to the GI stuff. I *******tw***** had my FET in November and will continue on metformin through my pregnancy. ****end tw**** it might help for sure. Good luck!!!