PCOS - is diet likely to be enough?

[Amummyatlast]

I'm trying to conceive no.2 after successful ICSI a few years ago for no.1 followed by an further unsuccessful round of ICSI (no plans to do any more). My GP (who is useless and couldn't even do the blood tests at the right time) states I don't have PCOS while my fertility consultant says I do have PCOS. Given that I have lots of symptoms I believe my fertility consultant.

So I'm going on a low GI diet in January and I'm wondering if this is likely to be enough, or should I try a find a private doctor and ask them to give me metformin? NB I am not overweight.

I don't have PCOS but the nutritionists I saw for my infertility issues do treat PCOS so you might like to consider a consultation/tests to supplement your diet if you haven't already www.marilynglenville.com/womens-health-issues/polycystic-ovary-syndrome/

Hopefully someone with more experience of PCOS will be along soon...

Hi
I struggled to with infertility for years. My GP was also useless and wouldn't refer me because I had been pregnant before (blighted ovum). I found a private fertility specialist, it was honestly the best money I ever spent.
He was the one that suggested PCOS & eventually diagnosed after an internal ultrasound. I also wasn't overweight & had absolutely no symptoms.
We tried metformin first, then clomid neither worked for me (I do know of success stories with both though) and eventually it was ovarian drilling that worked for me, again I had that done privately. Overall I think I spent £3k in total, my DD is 3.5 now

Thanks both

Ask fertility consultant for metformin, helps with insulin and therefore testosterone production. Very good drug if you can stand it (gives people tummy troubles, but I've never minded having the shits, being more of a constipated IBS kinda gal)

Deffo get metformin. Also worth taking inofolic

Counterintuitively 'classic' PCOS is easier to treat - ie if you're overweight, then you're more likely to be able to kick start ovulation by losing weight and getting your blood sugar under control. Or if not, then my Dr said overweight women tended to respond well to Clomid

He said lean PCOS women tended to be trickier, as they couldn't reverse symptoms with weight loss and were more likely to be clomid resistant

I was underweight and he wouldn't give me metformin until I was a healthy BMI - told me to eat low GL diet

Metformin also reduces the risk of miscarriage for women with PCOS

Good luck

Thank-you both. I think I'm going to try a few months of diet and then see if I can get metformin.

Hello OP. If you had ICSI (as we did too) that would suggest a male fertility issue too though, wouldn't it?
I have (or had) PCOS and am very lean, but was anovulatory, had acne, unwanted hair etc. I started on metformin and within a few months my skin had cleared up, I no longer had the unwanted hair and my periods restarted. I never got pregnant naturally though! My consultant at the Lister told me that PCOS is only a problem if you don't ovulate because of it. If you are having regular periods you are likely ovulating.

No male factor (both unexplained) - we did ICSI because we had no fertilisation on our first attempt with IVF. I do ovulate, but appear to have a problem with egg quality, so I'm hoping the low GI diet might help a little.

Could well do mummy. Good luck!

I was told that without Metformin and Clomid my PCOS couldn't be managed. My nhs gaenocologist is from India where they have many more cases of PCOS so am likened to believe her. Gaenocologist doesn't even want me to lose weight as she says any Bmi lower than 35 is unlikely to affect fertility, but I'm trying to get to around the mid-normal range for my height anyway. A low GI diet without metformin seems a bit pointless to me.

I wasn't allowed metformin when I was underweight because metformin does often caused weight loss (as indeed it has for me now I do take it. I had to stop as I was losing too much weight)

I was however told to eat low GL

Low GL without metformin may have been pointless for you but it depends on the individual.

People from the Indian subcontinent are more likely to get type 2 diabetes so their requirements for insulin management on a population level are likely to be different

I don't have PCOS but i have followed the story of Carisa Gilman on youtube who swears by her Ketogenic diet and has just given birth afyer ten years of infertility including failed IVF. She firmly believes that her diet has been the key factor.

I find her videos watchable and also inspiring to those struggling.

You should really just ask your fertility consultant (who would know better than your GP) to write to your GP and say you need a repeat prescription for metformin for PCOS - it's a pretty cheap medicine so there should be no ifs or buts if you need it. Your fertility consultant should be able to write you a prescription (whether they are private or NHS) for an initial course at least.

Diet alone can help PCOS but the metformin will make it easier to control (it does depend on how bad your PCOS is - if it's v bad then you will definitely need the pills). Just for reference, I have PCOS, ovulate regularly, regular periods, etc - the only real indicators are my overall hairiness :) and the fact that my ovaries apparently have the classic appearance of PCOS (whatever that is) and have been on metformin for a number of years.

My consultant did write to me/my GP when we last saw her (and said we didn't want to continue with any more treatment, so I'm not seeing her anymore). And in her letter she said I should request/be given metformin if my cycles get longer, but they have mostly stayed at my usual 35 ish days. So in my head I was thinking I would need to see a private GP, but maybe there is a way to get a letter from her re the metformin.

The potential for weight loss with metformin concerns me though, as I do not want to lose weight. And my reasons for a low GI diet include other health reasons as well as fertility. I had NHS treatment for DD, and to do that I had to put on a lot of weight (my BMI was way under 19), which required me to eat a lot of crap food. Unfortunately I haven't lost the habit of regularly eating biscuits, cake, etc., and I'm concerned about my future health if I continue, even through I'm not overweight (BMI of about 19.5 now). And I'm actually quite enjoying some of the food swaps I have made so far, such as changing to granary bread and having a roasted onion instead of lots of roast potatoes with my Sunday lunch.

Tammy, like you I don't have the weight gain/ovulation problems, but my ovaries do have cysts, I get excess hair on my face and I have male pattern baldness (fortunately hid by the rest of my hair). From the breast pain that I get, it also seems that I have estrogen dominance.

Metformin only really causes weight loss at the highest levels and I suspect only in people who have mild pcos. I take 1000mg per day and haven't had any weight loss and am not overweight. The metformin controls my excess facial hair and oily skin. It has alongside Clomid also helped to increase my progesterone levels consistantly month on month so I am ovulating. I think a visit to a private GP may well be in order just to get a second opinion - it might be that due to your bmi they aren't taking you seriously.

It took me 20 years for a diagnosis because I have no cysts and am a normal bmi. GP always dismissed pcos as an overweight person's disease which is wrong.

Even if you are not seeing your consultant anymore they should be able to write a letter to your GP about the metformin for you (and given you've been trying to conceive for a few years now I think you have a good case to make that you should be given it, whatever your cycle length is.) I guess your other option is to try to see another GP at your practice and plead your case. I think it's worth trying, because otherwise you are always going to wonder if it would have made a difference. In the meantime you could consider inositol (which you can get from Amazon and is not expensive, and is sometime recommended for PCOS although I'm not sure it's backed by any scientific data).

When I was first diagnosed the consultant I saw said that it was a myth that you had to be fat and hairy to have PCOS.

Agree with asking for a referral to a specialist - when I told my GP about the PCOS diagnosis she said she didn't realise skinny women could have it!! I mean, FFS?!

I went straight onto the miscarriage dose (850mg twice daily) when I got pregnant, as I'm having treatment to work on my endometrium (the likely cause of my two miscarriages) and am not trying to get pregnant until we do a frozen embryo transfer cycle, I don't need to take it (I'm on medications so wouldn't be having natural cycles to regulate anyway)

My Dr recommended Inositol, I take Inofolic sachets, although you can get the powder cheaper, it's just convenient to get the right dosage in the sachet format

I sympathise with putting weight on - my Dr wouldn't begin treatment until I'd got my BMI up to 18.5. Protein powder and Greek yogurt was very helpful!