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Key takeaways
Metformin is often prescribed in women with PCOS who are having trouble conceiving.
Metformin can help regulate menstrual cycles in women with PCOS and induce ovulation.
Metformin may also help with PCOS, which may increase fertility.
Drugs like Clomid are usually the first line of treatment for fertility in women, but metformin may be recommended if you have PCOS.
Metformin is a medication used to treat Type 2 diabetes. It works by regulating blood sugar levels and increasing the body’s sensitivity to insulin. Many people wonder if you can use metformin for fertility. They may ask: Does metformin help you get pregnant?
The answer is that metformin can increase fertility among women who have polycystic ovarian syndrome (PCOS), a condition affecting 5-10% of women. Women with PCOS have trouble ovulating and also have trouble regulating their insulin. Metformin can help you ovulate more regularly. It can also moderate glucose levels in your body, leading to weight loss, which can also improve fertility.
Here, we’ll take a closer look at metformin and fertility, including more information about how metformin can help certain people get people pregnant, how long it takes to work, any potential risks or side effects, and other available medicines to boost your chances of getting pregnant.
Can metformin help you get pregnant?
If you’re wondering, “Does metformin increase fertility?” The answer is yes. “Metformin can be helpful in achieving pregnancy,” says Mitchell Kramer, MD, OB-GYN, chairman of the Department of Obstetrics and Gynecology at Huntington Hospital. Specifically, it’s used to treat fertility among women who have PCOS. Metformin can regulate your menstrual cycle and help you ovulate more frequently, thereby increasing your chances of conceiving.
Dr. Kramer says that while the use of metformin will make you ovulate more regularly and predictably, it won’t alter your egg quality. Additionally, while other types of fertility medication can increase your risk of twins, metformin won’t do that. For example, the risk of a twin pregnancy is about 3% for people who take letrozole and about 7% for people who take Clomid. However, using metformin “does not increase the risk of a twin pregnancy,” Dr. Kramer assures.
How long does it take for metformin to work for fertility?
According to Adi Davidov, MD, associate chair and Director of Obstetrics and Gynecology at Staten Island University Hospital, metformin can be helpful when it comes to the process of getting pregnant, but “it can take a few months for it to help increase your fertility,” he describes.
Every woman is different when it comes to how quickly fertility will return or increase. You will know that you are fertile once your periods become more regular because this indicates that you are also ovulating more frequently. You can use an ovulation detector kit to determine if you are ovulating, or you can visit your healthcare provider to help you understand if ovulation is occurring at a more frequent rate.
How does metformin help fertility?
The main way that metformin impacts fertility is by regulating the menstrual cycles of women who have PCOS. It treats cases of anovulatory infertility. A 2019 review published in Cureus looked at 25 research articles and studies published over the prior ten years about metformin and menstrual cycles. The review concluded that treatment with metformin is “highly effective” in treating menstrual irregularities among women with PCOS.
Metformin “helps correct hyperinsulinemia seen in women with anovulation with PCOS,” Dr. Kramer describes. This means that it corrects high insulin blood levels and induces ovulation. “In doing so, it helps regulate menstrual cycles, and ovulation is more predictable,” Dr. Kramer explains. Women with PCOS often have unpredictable periods, which can make it challenging to time sex for pregnancy. Once you are ovulating more regularly, intercourse can be timed more easily, and conception will be more likely, Dr. Kramer says.
In addition to ovulation regularity, the use of metformin can help women with PCOS moderate their glucose levels and help with issues like insulin resistance. This may help you lose weight. Metformin “helps women with PCOS lose weight, and this in and of itself enhances fertility again by achieving regular cycles and ovulation,” Dr Kramer describes.
What is the best fertility drug to get pregnant?
It’s important to note that while metformin is often recommended for women with PCOS who are having trouble getting pregnant, it’s not a first line of treatment for fertility in general.
“Current professional guidelines do not recommend that metformin be used as first-line therapy to improve fertility because medications such as clomiphene citrate and letrozole are more effective in stimulating ovulation in women with PCOS who have difficulty ovulating on their own and lead to higher birth rates over metformin,” says Janet Choi, MD, board-certified reproductive endocrinologist and Chief Medical Officer at Progyny.
Whether to use metformin or another type of fertility drug, such as clomid, depends on the cause of the fertility, says Dr. Davidov. “In general terms, the most potent class of fertility drugs are the gonadotropins,” he says. Gonadotropins include both clomiphene citrate and letrozole.
Women with PCOS can use drugs like Clomid, metformin, or both, Dr. Davidov says. Usually, Clomid or letrozole are tried first. But if you have PCOS as well as glucose intolerance, you may also be given metformin, he explains.
Dr. Choi says that in general metformin is safe to use and hasn’t been associated with an increase in birth defects. Sometimes metformin has gastrointestinal side effects and other side effects, such as:
- Upset stomach
- Nausea
- Diarrhea
- Symptoms of low blood sugar, such as dizziness
Before you are given any type of fertility treatment, it’s important to visit your doctor so your treatment can be tailored specifically to your medical needs. “Prior to putting patients on these medications, if they are desirous of conceiving, they should undergo an infertility workup and evaluation,” Dr. Kramer advises.
Sources
- Metformin, MedlinePlus (2024)
- Metformin in women with polycystic ovary syndrome (PCOS) for improving fertility, Cochrane Library (2020)
- PCOS (Polycystic Ovary Syndrome) and diabetes, Centers for Disease Control and Prevention (2022)
- Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome, Cochrane Library (2020)
- Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics), UpToDate (2023)
- Letrozole versus clomiphene for infertility in the polycystic ovary syndrome, New England Journal of Medicine (2014)
- Ovulation induction using Metformin – patient information, Cambridge University Hospitals
- Is metformin the answer for distressed females with menstrual irregularities?, Cureus (2019)
- Role of metformin for ovulation induction in infertile patients with polycystic ovary syndrome (PCOS): a guideline, Fertility and Sterility (2017)
- Patient education: Infertility treatment with gonadotropins (Beyond the Basics), UpToDate (2023)
- FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function, U.S. Food and Drug Administration (2017)