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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

Diabetic Medication
for PCOS or Infertility

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General

Some diabetic medicines work by increasing the sensitivity of the body to insulin. The use in PCOS (polycystic ovarian syndrome) or infertility is "off-label" and is currently being investigated.  "Off-label" means that although it is not approved for marketing for PCOS or infertility, we can use it.

These have the ability to correct hormone function in certain women.  These can also decrease hair growth, lower abnormal hormone levels and increase the chance of ovulation.  The increase in ovulation can occur without other medications.   But, at other time, Clomid or other medication may still be required.

Glucophage (Metformin®) is the most studied of the medications available. But rosiglitazone (Avandia®) and pioglitazone (Actos®) may have fewer side side effects in some women.  Use of two of these in combination can also decrease side effects.

The medication should be stopped for some x-rays and for surgery.  The main side effects of Glucophage are nausea, vomiting, diarrhea, bloating and abdominal cramping.  In women with kidney disease, liver disease, pancreatitis, circulatory problems or infection, other metabolic problems can occur.  Patients with alcohol related pancreatic or liver damage have died on these medications.

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Alternative Treatment

Other treatment can include hormonal withdrawal for control of bleeding, birth control pills for hair growth or control of bleeding, other medication for excess hair, clomiphene or other ovulatory agents for fertility, in vitro fertilization, weight reduction clinics and surgical procedures. The choice of these is dependent upon the problems to be treated 

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Dosage

Metformin® (glucophage) is started at one 500 mg tablet a day.  The dose is increased to twice a day the second week and three times a day the third week. Three a day (1,500 mg a day) is continued for 4 weeks and the blood tests are repeated.  If the insulin level is normal, this dose (1,500 mg a day) is continued and decisions are made regarding clomiphene and/or other medications.  

If the insulin level is abnormal, the dose is increased to 850 mg twice a day for one week and then three times a day. Three a day (2,550 mg a day) is continued for 4 weeks and then the tests are repeated. If the insulin level is normal, this dose (2,550 mg a day) is continued and decisions made regarding clomiphene and/or other medications.

If the insulin level is still abnormal, additional medication or further evaluation is needed. If there are side effects or abnormal biochemical testing, the medication may need to be changed or stopped.

Avandia® (rosiglitazone) is started at 2 mg daily and increased to 2 mg twice a day. Avandia is increased at 4 week intervals if fasting blood insulin levels are still high. This can be increased to 8 mg daily. If Avandia is used in combination, it is increased up to 4 mg daily.

Actos® (pioglitazone) is started at 15 mg daily and can be increased to a total dose of 45 mg daily. Actos is increased at 4 week intervals if fasting blood insulin levels are still high. If Actos is used in combination, it is used at up to 30 mg daily.

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Blood Tests

Blood tests are done before starting the medication and then every 4 weeks.  The tests include liver function, kidney function, diabetes and male like hormones.  If any of these are abnormal, they are rechecked while on medication to see if they improve.

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Insurance Coverage

Insurance companies may not cover the "off-label" use of medication or the testing used to monitor this medication.  If you want to know if your insurance company is going to cover this, you need to get written clarification.

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