There are several routes a woman can take when she wants to get pregnant with PMOS, says David A. Ehrmann, MD, the director of the University of Chicago Center for PCOS.
Weight Loss
Weight loss is one common approach, since as many as 80 percent of women with PMOS are overweight or obese, and weight loss can be an important step toward successful ovulation. “Sometimes weight loss is enough [to help a woman get pregnant]” says Dr. Ehrmann. And it’s not necessary to drop it quickly via fad diets, either. Some research indicates that a 5 to 10 percent weight loss over six months will help induce ovulation.
Clomiphene and Letrozole
Whether you take letrozole or clomiphene depends on your circumstances. And it’s important to note that neither is a sure-fire path to pregnancy. One landmark double-blind trial from 2014 followed 750 women with PMOS who were trying to get pregnant. The study found that treatment with letrozole led to a 61.7 percent ovulation rate and a 27.5 percent live birth (delivering a baby) rate after five cycles, compared to 48.3 percent and 19.1 percent for clomiphene, respectively. Both medications can cause side effects, such as hot flashes (more common with clomiphene), dizziness, and fatigue (more common with letrozole).
Metformin
Metformin (Fortamet, Glucophage) is a medication to help control blood sugar in those who have type 2 diabetes. It’s also used off-label as a PMOS treatment, especially for those who have insulin resistance. Though metformin has a long history as a PMOS treatment, and it can help regulate menstrual cycles, it isn’t considered a first-line treatment option to induce ovulation.
According to a narrative review of the research, metformin increased success rates for ovulation, pregnancy, and live births better than a placebo. Success rates were even higher when metformin was combined with other medications, such as clomiphene. The results also suggested that metformin was most helpful for women who also have insulin resistance. Around 40 percent of participants reported side effects, though these were categorized as mild. Nausea, diarrhea, and vomiting were the most common side effects. More research is needed to understand the long-term health effects of metformin and its possible effects during pregnancy.
Another review also found that metformin was most effective when combined with other medications. The study, which analyzed 17 studies to summarize the most reliable PMOS infertility treatments, reported better outcomes when metformin was prescribed alongside letrozole or clomiphene.
In Vitro Treatments
If ovarian-stimulating drugs aren’t effective (or they’re not the best option for you), your doctor may recommend exploring in vitro fertilization (IVF), which offers a higher chance of success than medication alone.
Another possible treatment for PMOS women is in vitro maturation (IVM). Unlike IVF, which involves collecting mature eggs, IVM harvests eggs before they are matured via a surgical procedure.
IVM may be the best alternative for women with PMOS who also need to manage a condition known as ovarian hyperstimulation syndrome (OHSS), which is a known risk for women with PMOS. One meta-analysis of eight studies involving participants with PMOS reported similar fertilization and pregnancy rates between IVF and IVM, and found that IVF resulted in more live births.
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