PCOS - metformin and losing weight before trying Clomid

marianitamr

Hi there,

So, after all the testing was done I recently met with my RE for the first time and he diagnosed me with PCOS. All else is ok, tubes clear, normal shaped uterus, DH's sperm are top notch, etc. The only problem is that I am not ovulating because of the PCOS.

My RE suggested we treat with Clomid, so he gave me a prescription for Provera and 50mg of Clomid to start, and instructed me to have BW done on CD23 to confirm if ovulation occured and increase the Clomid dose if it didn't.

However, when I told my cousin, who is a doctor, about the plan; she told me that a less aggressive way to treat PCOS is with diet and metformin, and that with Clomid I could probably ovulate, but wouldn't be treating the underlying issue of insulin resistance and all the ovarian cysts. I am also in the obese category, with a BMI of around 34, so she also worries about increased risk of preeclamsia and gestational diabetes if I do get pregnant now.

I am super bummed about putting off Clomid, as I was looking forward to getting that little push I need to finally ovulate and maybe get preggers soon. However, after a lot of thought, crying, being angry, in denial, and finally acceptance, I have come to terms with a decision. I beleive that it would be a good thing to try to lose weight first and see if that can help me ovulate on my own. The way I see it, its a win win... I will be in better health overall, might ovulate on my own, decrease risks of being obese and pregnant, and maybe be a hot mama with a cute bump when I do get pregnant, lol .

The obvious downside is time... more waiting, painful waiting... I am thinking about trying this for at least 3 months, or until I've lost at least 15% of my body weight, before reconsidering Clomid.

What do you girls think? Anyone on the same boat? Would you try more aggressive fertility treatments and ignore the weight issue? Or try and lose it first, even if it means putting it off longer?

GraceInCA

I am almost in the same boat. My BMI isn't great, and I've packed on over 40 lbs since last year's miscarriage. The doctor and I discussed at length what we would do. He believes sincerely that my weight gain is the source of a lot of my issues.  The plan now is to treat me with Clomid, while simultaneously working on weight management. I do feel a tremendous amount of guilt, because I know my weight is likely the source of most of my fertility troubles. I'm no longer a spring chicken, so I'm moving forward with this treatment plan. Ideally, if I was younger, I would have given myself a year or two to slim down.

If you are under 35, you have time on your side. At a very moderate weight loss rate of 1.5 pounds a week, that will be almost 80 pounds lost in a year. When you start at a higher weight, you can even safely lose more. That will make a major difference for you in the long run.

Best of luck to you in whatever you decide.

Shayliz

Are you sure this is an RE? You should be having regular monitoring ultrasounds while on Clomid, not just a CD23 blood draw. I would find a new doctor if you decide to do fertility treatments.

If you have insulin resistance, you should be on Metformin whether or not you take Clomid.  

imwithrebel

I was at a similar point last year and wish I had been more aggressive. Yes, Metformin helped regulate my cycles a lot, but it wasn't enough. Before I started Metformin, I was ovulating really late (CD45+) or having anovulatory cycles. Each cycle was better than the one before and I started ovulating around CD30 about 6 months later. However, it was still a very weak ovulation and I would start bleeding only 10 days later. On the positive, I have lost 25 pounds in a year without really trying just from the effects of the Metformin normalizing my system.

Metformin can definitely help and may make the difference if you're really close to ovulating on your own, but from what I've experienced and read from other women, unfortunately Metformin often doesn't seem to be enough on its own.

Good luck with whatever you decide!

Svenny1011

I know how you feel about waiting. I could have started Clomid this cycle, but decided I'd rather see if the Metformin alone would work. I have a short LP, and Clomid wouldn't necessarily fix that (it could, but isn't guaranteed). I knew that if I got a BFP, I'd be terrified and stressed of another miscarriage, as my cycles wouldn't have shown any improvement to prove otherwise. So, I'm waiting to see if my cycles lengthen out so I can feel more confident moving forward, even if I still need Clomid in a few months. While I don't need to lose weight, I have read about how exercise can benefit women with PCOS. I joined a gym last cycle and have been working out regularly. I'm hoping the Met + exercise will be the key to regulating my cycles. 

Soooo, I'd say as hard as it is to wait, it might be worth it in order to build up your confidence and know that your body is working more properly when your BFP does come.  

Jezebell26

I definitely recommend weight loss. The only answer we have for my m/c right now is the pcos combined with obesity. So I have been on a treatment break to lose weight. I started metformin in January and am doing IVF #3 in June. I have 20lbs to go. You can do this if you really want to! GL!

ungraceful13

I have PCOS and was overweight. I am doing Metformin and using that and South Beach I lost 10 lbs. I was ovulating before but now I am ovulating earlier. It might not be a bad idea to try it first. It probably couldn't hurt. 

MonsterBean3815

I am in a somewhat similar boat.  I have had serious cycle craziness since going off BCP in July of last year.  I am seeing an RE tomorrow to figure out what is going on.  My OBGYN suspects PCOS.  I am a good 40 pounds overweight and have decided to postpone any treatment for fertility until August so I can focus on getting my body healthy.  I started South Beach Diet today and have started Jillian Michaels Body Revolution!  I am sad to have to wait, but 3 months is nothing but a drop in the bucket and could make the difference in my health and the health of any future pregnancies!  Good luck to you!

diamante1181

Considering all the things Dr.Cousin said, she is dissuading you from taking the very thing that is supposed to be helping you. I think that there would be nothing wrong with responsibly trying to manage your weight while following the RE's suggestions. That is what I am trying to do also, as I only started taking metformin last week. You should go with whatever in your heart rings true. Second opinions are probably best left for those with no emotional bias. Food for thought. 

imwithrebel

diamante1181:

Considering all the things Dr.Cousin said, she is dissuading you from taking the very thing that is supposed to be helping you. I think that there would be nothing wrong with responsibly trying to manage your weight while following the RE's suggestions. That is what I am trying to do also, as I only started taking metformin last week. You should go with whatever in your heart rings true. Second opinions are probably best left for those with no emotional bias. Food for thought. 

Very well put. You could also talk to your RE about what your cousin is suggesting and asking what they would estimate your odds of conception are with that plan vs. your odds of conception with the plan they suggested.

lady_chance_99

diamante1181:

Considering all the things Dr.Cousin said, she is dissuading you from taking the very thing that is supposed to be helping you. I think that there would be nothing wrong with responsibly trying to manage your weight while following the RE's suggestions. That is what I am trying to do also, as I only started taking metformin last week. You should go with whatever in your heart rings true. Second opinions are probably best left for those with no emotional bias. Food for thought. 

**Lurker Chime In**

This is pretty much what I decided last month, I was in your position as well. My RE and my ob/gyn both are okay with me cycling and even getting pregnant as long as I understand two things 1) That I need to keep exercising and watching portions/calories so I can keep heading in the right direction weight wise, and 2) That the moment I get pregnant I am to be on a diabetic diet (which should help with the weight loss even while pregnant while still giving my body what it needs, as well as helping to keep all my sugars in line before they have a chance to mess up). Every pound I lose makes my cycles a little more likely to take and at the same time I am still giving myself the ability to keep trying. Whatever you decide... GL

knoll

I am in the same boat.. PCOS overweight my BMI is 35. Metformin does nothing for me. I am taking Femera as several cycles with Clomid did not work..

 My doctor said to watch what I eat while trying but to not "DIET" unless I wanted to put trying on hold..

 

Good luck 

JMay

I have to chime in as well.  I've been TTC #2 with PCOS for over 3 years - and I've been working on my weight for longer.  The downside of PCOS is that you can diet and exercise all you want, but it's not going to make the same kind of difference you might see in someone else.  I'm a huge fan of being very careful of what you eat - just know that hopping on Metformin and the treadmill won't necessarily get you a drastic drop in weight.  If you are committed to getting exercise as a way of life, and you have a healthy diet (or make the changes needed to get there) you can be healthy even if you are not "thin".  My BMI is 30 and ideally, I'd be in a healhty range if I lost 35 lbs, but I swear to you I have the healthiest diet among anyone I know.  Just don't beat yourself up too badly.  I've been there, and it sucks. 

Also, make sure you are being monitored properly.  This includes a CD3 ultrasounds and bloodwork (Estrogen or E2), a mid-cycle u/s (they usually start at CD11 or 12, then you may need more if the follies are not yet ready) then finally bloodwork about 7-10 days after ovulation (progesterone level or P4) to confirm strong ovulation.  If clomid does not work, as is often the case for those of us with PCOS, ask the RE if you can give Femara a try.  There are some warnings, but with proper education on the topic I'm sure you'll see why so many of us take it.

If it were me, I would be a bit more aggressive, but I would not ignore the weight issue.  As I said, make being and eating healthy a part of your every day life, not just a one-time weight-loss effort.  If that's being done, I see no issue with you proceeding with the treatments your doctor recommends.

P.S. IMHO, the only doctors who know jack about PCOS are the REs.  The others talk about it, but do not seem to have all the information/experience.  They slap on clomid and metformin and BCPs, all of which are band-aids that cover the real issue.

PPS. Check out The Infertility Cure by Randine Lewis.  There is some great info in there about PCOS and how to manage it with your food intake. (Food as medicine)  It's usually available at the library or through library loan.

PPPS. The last one, I swear!  I've been ttc #2 for 3 years now, but I have to tell you, DC #1 came along when I was much heavier - almost 50lbs heavier.  But I ate well and walked and did not have any issues with PreE or gestational diabetes or the like.  I know we're not all the same, but it is possible to be overweight and still have a healthy pregnancy.

I wish you the best - from one PCOSer to another!!! 

Jenna

racheyt0227

Shayliz:

Are you sure this is an RE? You should be having regular monitoring ultrasounds while on Clomid, not just a CD23 blood draw. I would find a new doctor if you decide to do fertility treatments.

If you have insulin resistance, you should be on Metformin whether or not you take Clomid.  

 

Hello, is anyone listening to this advice? Never just go on Clomid & only get CD 23 bloodwork. That is beyond negligent. So many things can go wrong with unmonitored Clomid. Please do your homework. 

 

 

imnotsotough

First off - this is our first run in with problems TTC. We had our first daughter (surprise!) without a problem - it seems now that we are trying and perfectly ready - things don't want to work in our favor. 

In November we conceived on our own (my periods prior had been pretty off) and then after getting the positive result from my doctor, we lost our poppyseed 2 weeks later. After that I was staying pretty positive, that if I had gotten my period, then I should be getting it again. Well, I never did. So I met with my OB/GYN who decided to put me on the clomid/provera mix to help get me pregnant. No luck. Well, about that time my insurance had changed and therefor, I wasn't able to see the same OB/GYN. So, with my new insurance I met with my primary who noticed that my last cycle was November 2011, so she wanted to dig deeper and see what was going on. After blood work and an U/S we found that I have PCOS. I am overweight (not severe, but enough) so she wanted to start me on Metformin, and then we will go from there if need be with the provera/clomid mix. This ride on the metformin has been horrible for me. I know right now it is all side effects -- but man oh man.

 Stay strong - stay positive - we can all get through this struggle together.

Native+Girl

I will say this, when I was first put on Metformin for PCOS, I had also started a very low carb diet around the same time. After no period of going on 6 months, I had 4 normal cycles with the Met and low-carb. On the diet, I lost 30lb in 17 weeks, but the it wasn't sustainable and my cycles stopped as soon as I started adding carbs back in and put back on about 10lbs, putting me about 5lbs into the Overweight BMI. I can't say for sure the diet/weight loss was what was causing my normal cycles or if maybe I just stopped responding to the Met, so take it FWIW.

I think you're making a great decision by trying to get healthier before you get pregnant. And I think it's one you'll be happier with in the long run. Best of luck to you!!

bluek210

I was just diagnosed with PCOS after being off the pill for 6 months and having ridiculously long cycles.  It had been suspected in the past, but I didn't have many symptoms while on the pill aside from obesity.

 

I have lost 45 lbs in the last year and am finally at a "normal" BMI and a healthy weight. I've never had the insulin resistance part of PCOS.  Even being at a normal, healthy weight, and exercising 5 days a week, my PCOS and wonky ovulation/cycles have not changed (sadly). I started Clomid on Sunday (CD 3) and go in for an ultrasound day 13 (next Friday). 

 

So, just realize that all the effort it will take to lose weight and work your ass off may not change the situation. It may be worth a try if you're younger, but I'm 33 and feel the clock ticking! 

Shayliz

racheyt0227:

Shayliz:

Are you sure this is an RE? You should be having regular monitoring ultrasounds while on Clomid, not just a CD23 blood draw. I would find a new doctor if you decide to do fertility treatments.

If you have insulin resistance, you should be on Metformin whether or not you take Clomid.  

 

Hello, is anyone listening to this advice? Never just go on Clomid & only get CD 23 bloodwork. That is beyond negligent. So many things can go wrong with unmonitored Clomid. Please do your homework. 

 

 

Thank you! I thought I had gone crazy when nobody else picked up on this.  

EmilyB15

I have PCOS and my RE put me on BCP for 6 weeks with instructions to lose weight before we started our first IUI cycle. I hated that I had to do it, but I did lose about 10 lbs. and we're now moving forward. My BMI was 27. I had already tried 4 clomid cycles and 1 femara cycle both with metformin and no weight loss. I didn't respond to any of them. The way my RE put it was if we can't get IUI to work, we'll move to IVF. The best possible chance of getting IUI to work is to try to get all conditions as close to ideal as we can for my particular situation. That meant losing weight. So it was better to take a 6 week break and lose some weight and try to get it right the first few times around then waste those chances and have to spend $20,000 on IVF. It doesn't mean that's the right choice for everyone and I know it's so hard to wait.

marianitamr

Shayliz:

racheyt0227:

Shayliz:

Are you sure this is an RE? You should be having regular monitoring ultrasounds while on Clomid, not just a CD23 blood draw. I would find a new doctor if you decide to do fertility treatments.

If you have insulin resistance, you should be on Metformin whether or not you take Clomid.  

 

Hello, is anyone listening to this advice? Never just go on Clomid & only get CD 23 bloodwork. That is beyond negligent. So many things can go wrong with unmonitored Clomid. Please do your homework. 

 

 

Thank you! I thought I had gone crazy when nobody else picked up on this.  

marianitamr

Shayliz:

racheyt0227:

Shayliz:

Are you sure this is an RE? You should be having regular monitoring ultrasounds while on Clomid, not just a CD23 blood draw. I would find a new doctor if you decide to do fertility treatments.

If you have insulin resistance, you should be on Metformin whether or not you take Clomid.  

 

Hello, is anyone listening to this advice? Never just go on Clomid & only get CD 23 bloodwork. That is beyond negligent. So many things can go wrong with unmonitored Clomid. Please do your homework. 

 

 

Thank you! I thought I had gone crazy when nobody else picked up on this.  

Thanks for the heads up. I'll discuss this with my doctor and ask for proper monitoring before I reconsider Clomid.