PCOS-DIET Messages for August, 2002: Re: Pregnancy

Re: Pregnancy

From: Victoria (anonymous@obgyn.net)
Sun, 4 Aug 2002 22:03:48 -0400

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> From: Renee <rcordrey@earthlink.net>

> Heard et al. Fertil Steril 2002 Apr;77(4):669-73
> They gave PCOS women met, and if they didn't start to ovulate, added clomid.
> In 40% ovulated on met alone. 42% conceived within 15 months of study. 69% of
> the conceptions were within 6 months. The miscarriage rate of all the women
> studied was 35%. High drop-out/drop-off-met rate.

40% is kinda low isn't it? That is really odd to have a high drop out and drop off rate.

> CJ Glueck et al, J Invest Med 2000
> He kept some women on met for the whole pregnancy, and stopped with pregnancy
> for others. 45% miscarriage without met, 9% with.

This sounds more like what I've heard.

> Jakubowicz et al. J Clin Endocrinol Metab 2002 Feb;87(2):524-9
> The early pregnancy loss rate in the metformin group was 8.8% (6 of 68
> pregnancies), as compared with 41.9% (13 of 31 pregnancies) in the control
> group (P < 0.001). In the subset of women in each group with a prior history
> of miscarriage, the early pregnancy loss rate was 11.1% (4 of 36 pregnancies)
> in the metformin group, as compared with 58.3% (7 of 12 pregnancies) in the
> control group (P = 0.002).

... doesn't he work a lot or publish a lot with Nestler? I think I recognize Jakubowicz' name.

> You're right, Victoria, that there are many, many causes for PCOS.

You know I swing back and forth on this. I think we will go after the insulin resistance connection first. It seems like the most reasonable thing to do and the easiest way to deal with at least half or more PCOS cases. What I have a hard time thinking about is one of the latest BCP studies I saw that said diabetes rates were lowered with BCP, but insulin levels were higher. If the insulin levels are higher, I would think we'd see that reflected in diabetes rates. We also have cases of people who do not show any signs of insulin or glucose problems, but do well on Metformin.

Do you have any ideas? You think it might just be Metformin resistance or just dosage increase or something totally different?

> But, is is
> plausable that met helps to stabilize out some of the other hormonal
> imbalances involved with unsuccessful pregnancies, just as it helps stabilize
> other hormones in non-pregnant women (improved ovulation, decreased hirsutism,
etc.).

Agreed.

> Victoria, I know you know the value of a control group. The Heard study you
> cite below may have been unfortunate in the population studied being
> particularly difficult to treat, by chance. Is this the same study as above?

I don't know. The study you pulled up was in Fertility and Sterility. I went back and didn't find where Dr. Perloe said where it was going to be in. I believe I asked him privately and he said it would be in SGI. Maybe it turned out to be in F&S after all.

> It didn't look at comparing Met to anything, really. It was more of an single
> group longitudinal study. The ones cited above aren't perfect either. But,
> they're fairly consistent in their findings.

True, both doctors are in favor of prescribing Metformin, and are highly pushing its treatment for PCOS women. While its great we have doctors trying to get at least some of us a solution, I don't want to get into a situation of where the patients are skewed to making something look good. When I was to go into the d chiro inositol study here, they were specifically looking for women who had high testosterone levels to go into the study. I was told that they were looking for them because the early data showed it worked best for them, and that's who they were looking for for the study. There have been some comments in regards to a couple ladies who felt that Dr. Glueck didn't really want to deal with them if they didn't have success on Metformin.

The only study I've seen is diet/exercise to Metformin, and I can't believe that no one can put together a group of PCOS women who wouldn't be willing to take the chance to be studied.

--
Victoria

> Renee

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