How do Clomid & Metformin work?

Clomid is a medication (taken orally) which stimulates the ovaries to produce a mature egg (ovulation). You will be told to start taking Clomid on day 2 of your cycle for five days. You will usually be started on a dose of 50mg, but this may be increased if you do not ovulate on 50mg. Whilst taking Clomid you will be asked to go in for a scan to observe if your body is responding to the medication. Treatment with Clomid is repeatable for up to 6 cycles.

There are side-effects associated with taking Clomid which include hot flushes, breast discomfort, headaches, bloating, dizziness, and mild depression. But these stop when you stop taking the medication.

Metformin can be administered instead of, or alongside, clomid in those with PCOS. This is to help treat the insulin resistance that is so often seen in PCOS which results in elevated insulin levels. These elevated insulin levels can impact the maturation of follicles in the ovaries and result in anovulation (a month where you don’t ovulate), therefore the thinking is that as metformin can increase sensitivity to insulin it can help lower insulin levels and therefore allow for ovulation to occur. It’s important to note that there are unpleasant side-effects to taking metformin and lifestyle changes including taking supplements like inositol can improve sensitivity to insulin without the nasty side-effects.

What about your BMI and the impact that has on treatment?

If you have a BMI above 25kg/m2 you may have trouble accessing clomid. Some believe that Clomid is less successful in those with larger bodies. This is usually because people in larger bodies require larger doses for the medication to be as effective, and most studies don’t take this into account. There are studies where the dose has been adjusted according to body size and conception rates were the same in all body sizes once ovulation occurred. 

If you are struggling to gain access to Clomid due to your body size, then I’d recommend taking the studies by Lobo et al., and Dickey et al., along with you to show your practitioner that it can be used successfully if the dose is adjusted accordingly.

What if Clomid or Metformin are not successful?

If these options are unsuccessful, then you may be offered other treatments (depending on the reason why the above options were deemed unsuccessful) or assisted conception such as intrauterine insemination or IVF.

Accessing support during fertility treatment

Undergoing fertility treatment can be incredibly stressful, this may have a negative impact on your relationship with your partner and result in decreased libido – kind of the last thing you need whilst trying to conceive, right? It’s important to remember that this isn’t an easy journey, and you don’t have to go it alone. It is recommended that all couples undergoing fertility treatment join a fertility support group and receive counselling – don’t hesitate to ask your practitioner to refer you for counselling or other forms of support that they have available. There are also amazing communities like The PCOS Collective where you can connect with other with PCOS who may be on a similar journey.