Everything You Need to Know Today About PCOS Fertility Medications
Navigating PCOS fertility medications can be tough, and particularly with PCOS. You may want to take fertility medications but every time you see your gynecologist she says she can only prescribe you metformin until you lose weight.
Or maybe you're on the side where you are hestitant about taking medications and yet you talk to your gynecologist and she says, "you're infertile and the only way to treat your PCOS is to get back on birth control."
It feels like walking through muddy water, am I right?
Today I'm going to share important information that will help bring clarity about these fertility medications. You will learn about the top PCOS fertility medications, what they do and when they may or may not be helpful.
Just remember, fertility medication recommendations can change quickly. I will update this article as I can but always talk with your doctor. And if they aren't open to having a conversation about which fertility medications are best for your situation and why, then find another doctor.
What You Need to Know About These Fertility Meds
Alrighty, let's dive in to this important topic! These are the top PCOS fertility medications that you are going to learn about today:
Metformin
Clomid
Letrozole
Progesterone
Ozempic
Ovidrel
Here's the thing, talking about medications can be a really dry subject so I'm going to try my best to lighten the conversation up and make it fun. Are you ready?
PCOS Fertility Medications #1: Metformin
What It Is
Plain talk? Metformin helps take away the feeling of being "hangry". Have you been there before? I certainly have!
In medical talk? It's a diabetes medication used to balance blood sugar levels.
For awhile, Metformin was the number 1 fertility medication prescribed for PCOS. Interestingly, it has since fallen out of favor and it's not recommended as a first line fertility medication anymore.
How It Helps Fertility
Metformin mildly helps lower hormones like testosterone, helps with weight loss and with keeping menstrual cycles regular.
When it comes to PCOS fertility, it is recommended to be used alongside other fertility medications like letrozole or clomid for it to work at it's best.
Fertility Pros
Metformin can help with weight loss and balance blood sugar levels if that's something you need help with. It is also helpful to help get eggs to ovulate, but only if blood sugar issues are one of your fertility struggles.
Fertility Cons
Metformin comes along with two side effects to watch out for so consider these before starting it.
The first side effect to watch out for is digestive issues. I'm talking about diarrhea and stomach cramping. It doesn't happen with everyone, but when it does happen? It's one of the top reasons why people stop taking the medication
The second side effect is that metformin lowers levels of vitamin B12 in the body. B12 is important not only for fertility, but also for mood and energy as well.
So lowering vitamin B12 levels in the body are not good if pregnancy is your goal!
Thankfully you can overcome this deficiency by supplementing with vitamin B12, but be sure you talk with your doctor about what this means for your body and fertility journey.
Okay, it's time for a joke break!
What did the snail who was riding on the turtle's back say? Wheeeee!
See, I told you that I was going to make this fun!
PCOS Fertility Medications #2: Clomid
What It Is
Clomid is a SERM. Are you familiar with those medications? They are selective estrogen re-uptake modulators. Wow, that's a long boring set of words.
How It Helps Fertility
Clomid is an ovulation induction medication. It works by blocking the estrogen that comes to the brain which then helps to increase LH and FSH and voila! Then ovulation is supposed to happen.
Fertility Pros
Researchers have found that women with PCOS will ovulate 80% of the time with Clomid, and pregnancy will occur between 30 and 40%.
Fertility Cons
Did you notice that pregnancy rates are half as much as the ovulation rates with clomid?
This big difference in ovulation and pregnancy rates is thought to happen because Clomid doesn't help with getting the uterus nice and ready for implantation.
Ovulation rates are also lower for people who are older, have more weight, have more androgens, and blood sugar issues.
Important side note here! This is why an individual fertility plan is the best step forward to improve chances of getting pregnant with PCOS. Be sure to work with a provider that can help lower androgen levels, balance blood sugar levels, help with weight, before recommending clomid.
Do you see how this improves your chances of getting pregnant?
Okay, after that brief intermission, now back to the cons of clomid.
One downside, or more of a neutral piece of information about clomid, is that it increases pregnancy with more than one baby, aka twins. In the medical world this is listed as a downside, but it may or may not be a downside to you.
One common side effect with clomid is hot flashes.
There's one last downside that I want to cover about clomid. Clomid is only recommended for 6 cycles, after that it doesn't work nearly as well.
PCOS Fertility Medications #3: Letrozole (you may also know it as femara)
What It Is
Did you know that letrozole is now the #1 recommended medication for PCOS fertility?
Letrozole is an aromatase-inhibitor which means it blocks an enzyme from working in the body and the result is (supposed to be) ovulation.
How It Helps Fertility
Letrozole is another ovulation induction medication. It helps to balance estrogen and FSH levels which then basically helps push the egg out to ovulate.
Fertility Pros
Letrozole is now recommended as the top fertility medication because recent research found there are higher pregnancy rates with letrozole versus clomid and metformin.
Letrozole also doesn't have the side effects like hot flashes or thinning of the uterus like clomid does.
It's also noted that letrozole doesn't induce as many twin or triplet births.
Fertility Cons
Two side effects that have been found with letrozole are fatigue and dizziness.
Animal studies have found a risk of birth defects associated with letrozole. As of right now, that finding hasn't been found with humban babies (thankfully!).
PCOS Fertility Medications #5: Progesterone
What It Is
Progesterone is an important pregnancy hormone. It rises in the second half of the cycle and helps with ovulation. Progesterone levels need to stay elevated after implantation happens in order to keep the pregnancy going.
Did you know there are both synthetic and bio-identical versions of progesterone? That's right. There's a big difference in the two so be sure and talk with your doctor about what is best for your situation.
How It Helps Fertility
Progesterone helps fertility by helping get the body ready for the egg and sperm to implant.
It also keeps the pregnancy going once you are pregnant! During the first trimester, it's your body's own progesterone levels that keep the pregnancy going.
Once the second trimester comes around? That's when the placenta takes over the job of giving progesterone to the baby.
Fertility Pros
Progesterone is a very safe hormone to use. It not only helps with fertility, but also helps improve mood and sleep.
Fertility Cons
Bio-identical progesterone is very safe. When it comes to fertility support, there really are no cons. It's such a safe hormone that it can be purchased over the counter at the store.
But synthetic progesterone has a different story. There are side effects to the synthetic version like blood pressure changes, blood sugar changes, and mood issues.
PCOS Fertility Medications #6: Ozempic
What It Is
Ozempic is a medication that helps with weight loss. It does this by changing appetite levels.
How It Helps Fertility
Ozempic is not a specific fertility medication but right now it is very popular to help with weight loss and PCOS which is why I'm including it here.
Fertility Pros
Sometimes, extra weight can cause blood sugar and insulin levels to get too high. This can shut down ovulation which is why weight loss may be a part of a PCOS fertility journey for some people.
Fertility Cons
Side effects include things like constipation, diarrhea, nausea, and vomiting.
There is also an increase risk for thyroid cancer, particularly for those who have a positive family history of thyroid disease.
Weight loss medications need to be used wisely and only if absolutely necessary. The pros and cons for a weight loss management medication needs to be looked at very closely to see if it's important for your fertility picture or not.
If your doctor is talking to you about a weight loss medication like this, are they also helping you with a nutrition plan that's easy to put into place?
Have they also helped you figure out what's happening in your body that is keeping you from losing weight?
Those are important first steps before even talking about a weight loss medication.
PCOS Fertility Medications #7: Ovidrel
How it helps fertility
Ovidrel is an injection medication that's used typically with timed intercourse cycles along with letrozole or clomid, with IUI or IVF.
The ovidrel shot consists of the hCG hormone which helps to push the egg out of the ovary.
Fertility Pros
This shot is directly acting on the reproductive system to help push the egg out of the ovary, which is the first half of the goal (the second half of the goal being a healthy pregnancy, am I right?)
Fertility Cons
Ovidrel is not recommended for people who have an extreme thyroid or adrenal issue, so your doctor needs to make sure that's not a problem for you.
Hot tip for you! One missing fertility link is that many doctors only test for TSH to evaluate thyroid health and that's just not enough. I talk about this more in my article here.
This injection is also not recommended for people with premature ovarian failure.
Side effects of ovidrel include pain at the injection site and some mild digestive upset like nausea. Although since this medication acts quickly, side effects like the digestive upset shouldn't last long.
Summary
Phew, we made it! Now you know about which fertility medications are used for PCOS and the pros and cons of each of them.
Fertility medications can be an important part of the pregnancy journey. But in my expert opinion, they are often being used at the wrong time.
Here's what I mean about why fertility medications are being used at the wrong time.
Many doctors will recommend a medication like clomid or letrozole right away to help with fertility. But this misses the mark. Using one of these medications right away keeps your chances of getting pregnant low.
Is your doctor checking your vitamin D levels so you know if you're deficient or not?
Is your doctor helping you with a plan to improve egg quality so your eggs come out healthy and ready to make a baby?
Has your doctor done a comprehensive evaluation of your thyroid hormones so you know that's not keeping you from getting pregnant?
If not, these are important missing pieces to your fertility journey that need to be looked at right now. These are the missing pieces that keep your chances of getting pregnant low.
Improve your chances of getting pregnant with PCOS. Your first step is to book a free PCOS Fertility Breakthrough Session here.
This is what you will discover during your free session:
How to turn around your PCOS frustrations and be closer to reaching your fertility goals.
Why what you’ve been doing is leading you away from optimal fertility and what actually works.
What’s been missing from your care that’s keeping you from seeing results.
Clear step-by-step guidance to have your best chance at becoming pregnant.
*****UPDATE THESE LINKS*****Did you LOVE this article and are you excited to learn more about PCOS fertility? Check out these other articles and help boost your chances of getting pregnant with PCOS:
Do You Have One of These 5 Important PCOS Infertility Symptoms? What To Do About It Now
What’s the Best Prenatal for PCOS Fertility? 3 Powerful Tips
How to Improve Your Chances of Getting Pregnant with PCOS****
These are articles I used in writing this post:
Barbieri, Robert. Metformin for treatment of the polycystic ovarian syndrome. In: UpToDate, Wolters Kluwer (Accessed on September 20, 2023), link
Seli, Emre. Ovulation Induction with Clomiphene Citrate. In: UpToDate, Wolters Kluwer (Accessed on September 20, 2023), link
Casper, Robert. Ovulation Induction with Letrozole. In: UpToDate, Wolters Kluwer (Accessed on September 20, 2023). Link
Ovidrel medication information, link
