Infertility Treatments > Medical > Glucophage

    Polycystic ovarian syndrome (PCOS) is one of the more common conditions affecting the reproductive system of the female. While the manifestations of PCOS vary tremendously, women with PCOS may experience irregular periods, difficulty conceiving and signs of excess male hormones. Ultrasounds of the ovaries may reveal multiple small cystic areas within the ovaries, hence the name of the syndrome.

    It has been known for quite some time that one of the principle changes occurring in women with PCOS is a significant increase in insulin resistance. Experimental studies have, in fact, demonstrated that increasing insulin levels over a period of time will result in changes within the ovary that are indistinguishable from those seen in PCOS. There is good evidence that elevated insulin levels at the time of puberty may be what initiates the entire process of PCOS.

    Metformin, Actose, and Avandia are oral agents used in the management of adult onset diabetes. Actose and Avandia function by increasing the sensitivity of muscle and adipose tissue (fat) to insulin. This increase in insulin sensitivity results in lowered serum glucose levels, and lowered plasma insulin levels. Metformin decreases insulin levels by decreasing the rate of glucose production by the liver in addition to increasing insulin sensitivity.

    There have now been a couple of studies suggesting that the use of insulin lowering agents in women with PCOS results in improvement in this process. Much of the difficulty in achieving ovulation and pregnancy in women with PCOS seems to be due to the adverse effect of the elevated male hormones (particularly within the ovaries). The elevated male hormones seem to be a direct result of insulin resistance. The insulin lowering agents seem to improve the PCOS and may result in more normal ovulation and perhaps even pregnancy.

    Metformin is the medication of choice in lowering insulin levels. Avandia and Actose are reserved for those women who do not tolerate Metformin. A significant effect on the ovaries and the ovarian hormones can be expected within three months. The use of these agents will not result in restoration of normal ovulatory function in all women. However, even in those women who do not have restoration of normal ovulation, their responsiveness to clomiphene, for example, should be dramatically improved.

    After using these medications for three months follow-up testing will be performed to evaluate their effectiveness in restoring normal ovarian function.

    While the use of these medications significantly lower insulin levels, there are important things every patient can do to improve their condition - diet and exercise.

    DIET - Consider a low carbohydrate diet. Carbohydrates promote an insulin response within your body. If you are consuming a low fat diet in your efforts to loose weight, you are actually increasing the carbohydrates in your diet. This increases your insulin levels, and for women with PCOS weight loss becomes difficult if not impossible. A low carbohydrate diet may be much more effective and reduce your insulin levels in the process. The average American consumes 200-400 grams of carbohydrates per day. A low carbohydrate diet is typically 20-40 grams per day. This diet involves significantly reducing sugar, white flour, and refined carbohydrates and increasing the amount of protein (meat, eggs, cheese, and salad) in your diet. Avoid low fat foods.

    EXERCISE - An important if not vital part of this equation is to participate in regular aerobic activity. This means finding some activity that you can pursue 3 to 4 times a week for at least 30 minutes such as aerobics, riding a bike, jogging, walking rapidly, etc. It is important that this activity be one that increases your heart rate. Exercise lowers your glucose levels and thereby lowers your insulin levels.

© 2005 Jarrett Fertility Group