The Alan E. Beer Center for Reproductive Immunology & Genetics helps families grow by researching and treating couples who experience recurrent miscarriages, multiple pregnancy losses or repeated in vitro fertilization failures.

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Infertility, Implantation Failure and Miscarriages in Women with Polycystic Ovarian Syndrome (PCOS) and Treatment with Metformin

The information contained in this article is not intended to be a medical diagnosis, treatment or medical advice in any way, as it is general information and cannot be relied on without consultation with your physician. It is not intended nor is it implied to be a substitute for profession medical advice. As medical information can change rapidly, we strongly encourage you to discuss all health matters and concerns with your physician before embarking on new diagnostic or treatment strategies.

Polycystic ovarian syndrome (PCOS) is a disorder of ovarian resistance that can run in families and be inheritable. This disorder is associated with categories of immune problems that can lead to infertility and pregnancy losses. Apart from the immune problems associated with this disease it is characterized by:

  1. Increased fasting free insulin levels (hyperinsulinemia);

  2. Overproduction of Testosterone by the ovaries and the adrenal glands (male hormone);

  3. Overproduction of DHEAS dihydroepiandosterone sulfate (male hormone);

  4. Overproduction of Androstenedione (male hormone);

  5. Underproduction of Estrogen;

  6. Changes in the FSH/LH ratio from 2:1 to 1:1 FSH is usually normal LH is elevated;

  7. Low progesterone levels (luteal phase deficiency);

  8. Increase in weight due to increased numbers of fat cells stimulated by the free insulin;

  9. Complexion changes often with the reappearance of acne;

  10. Menstrual abnormalities or long periods between periods;

  11. Coarseness of hair, thinning hair, even male pattern hair loss;

  12. Increase in blood pressure;

  13. Increased tendency for the blood to clot too quickly.

The endocrine management of this disorder is well understood by reproductive endocrinologists; however, the immune changes that can subsequently lead to implantation failure and miscarriage when hormonally treated are poorly understood. This brief overview is to help you in this regard and equip you to ask that your physicians also test for the immune consequences of this disorder before entering a cycle of conception.

The most effective treatment for this condition is Metformin. This is a safe oral medication that decreases the fasting free insulin level and increases its effectiveness at the peripheral cell level. It will reduce the high insulin levels, decrease the male hormone levels, decrease the blood pressure and induce weight loss when dieting and exercise were ineffective in this regard. It reduces the level of the plasminogen activator inhibitor (PAI-1), corrects the fast clotting problem and decreases the risk of heart attack and stroke.

Metformin treats both the endocrine problems of PCOS and the metabolic problems. In my experience treated women have lower free testosterone levels, normal FSH/LH ratios, major weight loss, reduction of excess male pattern body hair, lower blood pressure, lowered triglycerides, LDL and cholesterol. Thrombophilia problems are also improved. In many women these changes restore fertility.

The following abnormalities are seen in women with this disorder.

  1. Low HCG;
  2. Low Estradiol;
  3. Low Progesterone;
  4. High Testosterone free and total;
  5. High LH (luteinizing hormone);
  6. High PAI-1 and PAI-2;
  7. High Free Insulin over 10.

This data is quite new and many doctors will not understand the significance of testing and treating for this disorder. Please feel to contact or work with us long distance if you have further questions by e-mailing info@repro-med.net.

The risk of miscarriage in patients with PCOS is considerably higher than in non-PCOS women. For more information, see a review of these studies.

I recommend that all women with ovarian resistance or PCOS read the following documents:

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Alan E. Beer Center for Reproductive Immunology & Genetics
15151 National Ave. #2; Los Gatos, CA 95032; Phone: (408) 356-9500; Fax: (408) 356-9509; E-mail: info@repro-med.net.
Date: 8-28-08, Time: 3:47 pm.

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