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Dr. Andrew Rynne

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Suggest treatment for PCOS while on Metformin

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1681 Questions

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Posted on Fri, 8 Dec 2017 in Pregnancy
Question: hi I'm a 23 yr old female being treated for pcos. I'm taking prescribed metformin (2000mg/day) I'm currently trying to get pregnant and was wondering if a doc could look at my chart and tell me if I possibly ovulated. this is my first month temping so not sure how to read my chart! I started charting in the middle of my cycle cuz that's when we doubled my meds. I'm currently waiting for my first cycle. since we doubled my meds. it will be my second cycle in 2 yrs!
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Answered by Dr. Timothy Raichle 1 hour later
Brief Answer:
Basal body temperature charting is not the best way to go

Detailed Answer:
Thank you for the question.

Just to clarify, PCOS is a condition in which women do not ovulate regularly and this is often closely related to insulin resistance. Placing women on Metformin is a way to reduce this insulin resistance and correct the problem of lack of ovulation.

When I look at your BBT chart, there is no clear indication of when or if you ovulated. As you probably know, your temperature will increase by about 1 degree F after you ovulate and in some women, this can be seen on the BBT chart. But, in my experience, this is one of the least accurate ways to track ovulation as you can see from your chart.

A better plan would be as follows:
1. Buy an ovulation detection kit over the counter (this measures a hormone called LH in your urine that increases with ovulation)
2. Talk to your doctor about a low dose of a medication called Clomid. Women with PCOS are going to have higher fertility rates of a combination of Clomid and metformin
3. Make sure that your doctor is doing proper lab monitoring of the metformin as it can have effects, for example, on your liver

Does this help?
Dr. Raichle


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Timothy Raichle 28 minutes later
is it true that women with pcos cannot use ovulation predictor kits? I've heard it doesn't detect the lh surge
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Answered by Dr. Timothy Raichle 6 hours later
Brief Answer:
This is not true

Detailed Answer:
If you are cycling normally (which might require the use of metformin and clomid) AND you are ovulating, the LH surge will occur. It might be that women with PCOS ovulate so unpredictably that they find it harder to detect ovulation. You can certainly continue with the use of the BBT charting, but as you can see it is very hard to see the trends that might occur with ovulation. I would recommend that you talk with your doctor about an additional fertility medication as well as using the ovulation predictor kits for a month or two.

Dr. Raichle
Above answer was peer-reviewed by : Dr. Kampana
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