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Infertility/Fertility/PCOS- can I conceive without metformin?


Hello, I'm 30 years old and have a 2 year old daughter.  We live in nebraska.  We tried to conceive for 14 months, 2 failed cycles of clomid, one of which was an IUI cycle.  I finally saw a specialist after 13 months.  She told me I had "skinny" PCOS and started me on metformin.  5 days after starting metformin we conceived our daughter (I was charting and using opks).  We want another baby, so I started metformin again last January thinking it was the magic treatment.  We have not yet gotten pregnant.  I stopped taking it in march due to the awful side effects.  I seem to be having regular cycles about 32 days apart, opks, cm and temperature indicate that I'm ovulating around day 18. I was not overweight but have recently lost about 10 lbs so i dont know if thats why im now ovulating kore regularly. Before we tried the first time, my cycles were often 30-70 days long.  My OB doctor wants me to try clomid.  My specialist is booked and I won't be able to see her for at least a couple more months.  

My questions:
Is it really likely that the metformin is what did the trick last time being that I had only been on it for 5 days?

Is taking clomid on its own if I'm already ovulating (or so it seems) going to be helpful?

Am I really ovulating or is it possibly immature follicles being released for some reason?

Should I be having an HSG before doing anything further? What tests should I request?

I don't know what to do, my OB doesn't seem very concerned or knowledgable about these issues, but there are only 2 Fertility specialists in my area an I didn't really care for the one we saw last time.  I really hate the side effects of metformin but will take it if I have to.  I am frustrated that I took it for a good year with no results.

Thank you so much in advance for your advice.

Hello Sara from the U.S. (Nebraska),

Let me take your questions in order;

1.  No.  In the PCO patient that responds to metformin, it takes 8-12 months to have an effect.  It was NOT a magic fertility pill. (It was a waste of money).  Metformin reduces the insulin levels in some PCO patients that have insulin resistance (30% of PCO patients).  It is not a medication that is used in ALL PCO patients if used correctly.  You probably did not need it.
2.  Clomid also is not a magic fertility pill, although many doctors use it as such.  Family practice and general Ob/Gyn doctors are the main ones that use it in that way.  Clomid enhances the chances of pregnancy by one of two methods: (1) it induces the ovary to ovulate if you are not already ovulating or (2) it increases the number of eggs that you ovulate if you are already ovulating.  In some cases, if the cycle is a little off, Clomid will help to correct the hormonal imbalance.  The question you should ask your doctor are (1) why specifically is she recommending Clomid and (2) what does she expect that it is going to do?
3.  Immature follicles do not "release" or ovulate.  If the egg does not mature, it will not disengage from the wall of the follicle, so it cannot release/ovulate.
4.  How long have you now been trying to get pregnant for #2?  Keep in mind that it takes the average woman 8-12 months to achieve a pregnancy and therefore, we don't consider a patient infertile until she has been trying for at least 12 months.  Have you been trying for that long?  If you have, then it might be wise to undergo an infertility evaluation, which includes an HSG.  This all should be done by a specialist.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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