"mild" PCOS, do i need metformin? insulin resistance?

[jkimtysons]

I was told that I didn't have PCOS because I'm thin and don't have the acne/male-related characteristics, have my period (33-35 day cycle), and ovulate monthly (confirmed via temping). Lo and behold, I have an AFC of 38 with the infamous "string of pearls" and high (18) AMH. Doctor now says I may have mild PCOS. I was anovulatory in college, but chalked it up to stress. Menstruated fine before that and then later on though. Age 34, no kids yet. Day 3 LH is 10, LH to FSH ratio s 1.3, so under the 2+ range that is indicative of PCOS.

So now I'm reading all about mild/lean PCOS, and metformin keeps popping up. Some people say that it's a must to prevent miscarriage/boost egg quality, others seem to prescribe a "wait and see." It seems to be most common for traditional PCOS symptoms, less so for mild/questionable cases, especially for those who ovulate on their own--but then some people still say that it's important. Not sure what to make of all of it. I don't think I'm insulin resistant--although I guess I could be even though I don't have the accompanying weight gain. I'd say I'm blood sugar sensitive if I don't eat...but doesn't everyone get hangry once in awhile?

Any insights/experiences with metformin from people with "mild" PCOS--whether it's needed or not--would be very appreciated. Shady Grove didn't mention it at all, so I'm not sure if I'd have to push them to put me on it. Should I be doing additional testing with an endocrinologist? It seems like the treatment protocol (Clomid, IUIs, then IVF eventually) is pretty much the same regardless. Is it worth seeing if I have insulin resistance (and if I am, then should I consider metformin more?)? Should I get my testosterone (or anything else) tested to see if I have more PCOS symptoms? (And would that change anything if the proposed treatment is pretty much the same?)

Any other tips for navigating ART (IUI or IVF) from folks with similar profiles would be appreciated. So far this is really the only thing on my end. We are just starting IUI. Everything else looks fine other than DH's morph is 3%. Gracias.

[Anonymous]

We did metformin with letrezole and IUI with similar stats and it worked!

[Anonymous]

I'm seeing an immunologist (Braverman), and he originally suspected PCOS, although I don't really have any signs and actually have a low AMH and moderate AFC. Normal periods. And then my fasting blood work came back normal too. Still he has me of Metformin, and quite a high dose, to help with egg quality. I think it's standard with all his patients, PCOS or not. I'd take it if I were you.

[Anonymous]

OP, have you had insulin resistance/glucose/A1c blood tests?
Metformin is not just for PSOS and you indeed could benefit from it if you're pre-insulin resistand and/or mild PSOS.

Also, I've read that you don't have to have the "string of pearls" to be diagnoses with PSOS according to some research, if you have other symptoms.

[Anonymous]

I am slender and rarely get my period naturally. I needed FSH to ovulate in order to conceive (Clomid did not work for me). I did not need metformin though was advised to take it during my second pregnancy.

I did not have GD, though I was asked to be careful with carbs given the predisposition associated with PCOS.

[Anonymous]

I wish I understood this topic better. I went to SG and got pregnant via IVF. The doctor told me I have mild pcos and higher testosterone. I have a longer cycle (33-37 days) and I'm not always confident I ovulate. But I never received treatment for it. Instead moved onto IVF since our insurance covered it. It worked on the first try.

With the next child I'd like to take a less aggressive route since we Will have had a child already. Who should I see when trying to get pregnant again?

The other thing to consider is I have a lot of frozen pgs normal embryos.

[Anonymous]

I ovulated but had a shortened luteal phase. After a year of trying on my own, I was diagnosed with PCOS and offered metformin. Pregnant on the first try. Ditto for the second kid. Go for it.

[Anonymous]

Anonymous wrote:I wish I understood this topic better. I went to SG and got pregnant via IVF. The doctor told me I have mild pcos and higher testosterone. I have a longer cycle (33-37 days) and I'm not always confident I ovulate. But I never received treatment for it. Instead moved onto IVF since our insurance covered it. It worked on the first try.

With the next child I'd like to take a less aggressive route since we Will have had a child already. Who should I see when trying to get pregnant again?

The other thing to consider is I have a lot of frozen pgs normal embryos.

If you'll be doing a frozen cycle that will (de facto) be less aggressive. You had success at shady grove, why would you move?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I wish I understood this topic better. I went to SG and got pregnant via IVF. The doctor told me I have mild pcos and higher testosterone. I have a longer cycle (33-37 days) and I'm not always confident I ovulate. But I never received treatment for it. Instead moved onto IVF since our insurance covered it. It worked on the first try.

With the next child I'd like to take a less aggressive route since we Will have had a child already. Who should I see when trying to get pregnant again?

The other thing to consider is I have a lot of frozen pgs normal embryos.

If you'll be doing a frozen cycle that will (de facto) be less aggressive. You had success at shady grove, why would you move?

I want to gender select. Shady grove won't let me.

[Anonymous]

Studies show a link between pcos and low vitamin d. Vit D is also linked to ovarian function, so it's worthwhile to get your levels checked and supplement up to the higher end of normal.

[Anonymous]

Anonymous wrote:I'm seeing an immunologist (Braverman), and he originally suspected PCOS, although I don't really have any signs and actually have a low AMH and moderate AFC. Normal periods. And then my fasting blood work came back normal too. Still he has me of Metformin, and quite a high dose, to help with egg quality. I think it's standard with all his patients, PCOS or not. I'd take it if I were you.

Interesting you mention this. I am also seeing an immunology-inclined RE (Abbasi) and she also suspected PCOS based on my long cycles, somewhat high AMH, and probably my weight though she didn't say so specifically. But other than the irregular cycles (32-45 days but always ovulating), high AMH, and lots of eggs seen on a scan, I didn't have any of the factors. All my hormone tests came back normal, my ovaries don't have the pearl thing, and I wasn't even insulin resistant. She put me on Metformin anyway. After a week of that we did IUI with letrozole and I am now 11 weeks pregnant (and taking a ton of immune and clotting-related drugs). Her view was that Metformin would help control the environment around the egg -- my issue was that I kept getting pregnant in cycles where I ovulated very late and then I would miscarry. She thought the Metformin and letrozole together would fix that. Haven't had the genetic testing yet so we'll see if it worked.

My OB agrees that Metformin can't hurt and may help, even if you don't have a formal PCOS diagnosis. Might be worth it to try.

[Anonymous]

We have almost the same stats (high AFC - 35 and high AMH - 49 but that's in a different measurement than what you have in the U.S.) and I also don't have any symptoms. I never had much trouble getting pregnant, but i had 4 miscarriages before having my first and 3 before having my second (and just had another miscarriage). My RE put me on metformin a month before I got pregnant with my second baby. Not sure if it was the metformin that helped or the endo biopsy the month before (I also had the biopsy right before getting pregnant with my first, so it might have been the biopsy that did the trick, since it's the only constant). I took metformin for the first 12 weeks. Good luck!

[Anonymous]

Op here, thanks for the helpful comments (and keep them coming!) I will ask my OB about metformin. Seems like it can help for a variety of situations. If anyone can think of reasons why not to take it though, let me know!

[Anonymous]

Anonymous wrote:Op here, thanks for the helpful comments (and keep them coming!) I will ask my OB about metformin. Seems like it can help for a variety of situations. If anyone can think of reasons why not to take it though, let me know!

I'm 21:51 and some people get some gastrointestinal symptoms but I didn't. You're supposed to start with a low dose and increase each week until you get your maximum preferred dose.

[Anonymous]

Does anyone know about the link between Metformin and depleted levels of B 12? Did anyone supplement b12 or something else specifically when they were taking Met when trying to conceive?