Glucophage

In the March/April "Medical Mailbox," Nancy Eagy asked us for information about prescribing the diabetes drug Glucophage to help achieve pregnancy. In her email, she said that her niece had been married 17 years with no children. The niece's doctor put her on Glucophage (although she is not a diabetic) and within two months, she became pregnant. Nancy added that she has a daughter-in-law who has been waiting to become pregnant for the past five years.

We sent her query to reproductive endocrinology expert Dr. Marguerite Shepard. Dr. Shepard's reply follows:

"Glucophage (metformin) is an insulin-sensitizing agent that has achieved recent popularity in the treatment of infertility believed to be caused by failure to ovulate, a condition called anovulation.

"The single most common cause of anovulatory infertility is polycystic ovary syndrome--a condition characterized by obesity, excessive hair growth, and irregular to absent menstrual periods. The syndrome can be present in lean women as well and may be associated with acne instead of excessive hair growth. At least 50 percent of women with polycystic ovary syndrome will be insulin resistant regardless of body weight.

"When a person is insulin resistant, the pancreas must produce excessive amounts of insulin to keep blood sugar levels normal. These excess levels of insulin have an adverse effect on the ovaries that interferes with normal ovulation. Glucophage makes tissues more insulin sensitive. As a result, lesser amounts of insulin are produced, and normal ovulation may be restored in affected women.

"Polycystic ovaries and insulin resistance may be suspected if a woman has any of the symptoms or physical findings noted above. A positive family history for type 2 diabetes would also increase suspicion that insulin resistance may be involved in fertility problems.

"The diagnosis of insulin resistance may be confirmed by having blood drawn for glucose and insulin levels after an eight-hour overnight fast if the woman is overweight, or one to two hours after a 75 g oral glucose load. Normal values for the response to a glucose challenge have not been established. Many physicians prescribe Glucophage based on history and physical findings alone without confirmatory testing. If insulin resistance is suspected, modifications in diet and exercise habits can help. Such changes include eating a well-balanced diet with an emphasis on appropriate amounts of protein, heart-healthy fats, and complex (rather than simple) carbohydrates, as well as getting at least 30 minutes of exercise daily."

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