Metformin, for many women, has been a miracle drug. It is the aspect of treatment that allowed them to finally conceive. Metformin is so popular it is almost expected as part of fertility treatment. So popular, in fact, that one client I referred to a reproductive practice here in Phoenix, before even being seen by her physician, was told by his receptionist…that she would be receiving a prescription for metformin on her visit.
That is not to say metformin is perfect, or that it is for everyone. A new article by a prominent PCOS researcher suggests that a"not so fast" approach to metformin use might be more appropriate. Dr. Dunaif at Northwestern University in Chicago writes that in her analysis of the data, metformin is no more effective than clomid in increasing pregnancy rates. She also writes that there is no evidence to support the use of metformin to prevent miscarriage or gestational diabetes.
She doesn't stop there. Mentioning the recent findings about increased cardiovascular risk with Avandia (rosiglitazone) and Actos (piaglitazone), she suggests that their use may not provide long-term health benefits.
Of course, I'm biased, being a dietitian and seeing our program work as well as it has, and I believe just a few simple dietary tweaks and diligent, consistent use of them…is incredibly important in the PCOS big picture. Whether or not you are pursuing conception.
If you're a woman considering or just beginning treatment for PCOS for infertility…or just PCOS in general, it might behoove you to bring this reference to your physician for review. These medications may still be appropriate in your individual case, but it is important to understand that no treatment is perfect or without risk. An informed decision based on input from both you and your physician will be sure that the best possible course of action was the one you decided on.
Dunaif A; Medscape. Drug insight: insulin-sensitizing drugs in the treatment of polycystic ovary syndrome--a reappraisal. Nat Clin Pract Endocrinol Metab. 2008 May;4(5):272-83.