Most patients who have PCOS do not have regular menstrual cycles and therefore they cannot be treated with Natural Cycle IVF (NCIVF) as it requires patients to have fairly regular menstrual cycles. This is an example of an interesting patient of mine who had irregular menstrual cycles, which upon taking Metformin became regular, thus allowing her to be successfully treated with NCIVF.
A.H. is a 34 year old female who came to see me for a consultation in June, 2010. She had never been pregnant after using no contraception for about 2 years. Her infertility was directly related to her PCOS. At another clinic she was first placed on Clomid 50mg for one cycle but she experienced severe headaches necessitating her to visit the ER for evaluation. Her husband’s sperm were normal and her tubes open. So, I suggested that she simply try Metformin with coitus for a few months but this did not result in pregnancy. Interestingly, her menses became much more regular, occurring now about every 40-45 days. About 50% of patients that I place on Metformin will develop regular menstrual cycles and many will spontaneously get pregnant without any other therapy. But unfortunately, this did not happen for A.H. So, she desired to try NCIVF.
In November, 2011, we transferred a single blastocyst embryo and she became pregnant in her first treatment cycle of NCIVF. She is now 8 weeks pregnant and I have referred her back to her Obstetrician. She took no Clomid or any other ovarian stimulation drugs, just Metformin which helped in making her ovulation and menstrual cycles more normal allowing her to undergo treatment with NCIVF.
Now, we perform NCIVF in almost all patients with infertility as long as their menstrual cycles are fairly regular. Although the use of Metformin in PCOS patients may be somewhat controversial, we have experienced amazing success with many of our PCOS patients whom we simply place on Metformin alone and they achieve a spontaneous pregnancy. When pregnancy does not occur, we find that many will begin to experience regular menstrual cycles and this allows us an opportunity to try NCIVF. So, yes, NCIVF can be performed in those patients with PCOS who have regular or mildly irregular cycles.
This January, we look forward to beginning our 6th year of performing NCIVF! Dr. D