# IVF/ICSI with polycystic ovaries



## Lou32

Hi there
I'm hoping some of you might be able to help share your experiences and treatments...
I have polycystiv ovaries, but was never diagnosed with Polycystic Ovary Syndrome as I have regular cycles, I ovulate normally and my hormones are normal. Unfortunately, we need ICSI due to OH's v poor motility. I've had two failed ICSIs (SP) and both times been on the lowest dose of stims (150 iu or puregon or gonal f). First time I got 14 eggs and second time 21. 
Obviously, having PCO it means I respond easily, although I've never over-responded.
At our follow-up the doc said that women with PCO can have egg quality issues. This is the first I've ever heard this, especially as I don't appear to have any hormonal problems, and the embryologists have never had any issues with my eggs. Has anyone else ever heard of this? He also said there's an increased chance of miscarriage...!
I asked what i can do and he didn't have any advice at all. 
For our third try, he wants to reduce my stim drugs to below 150 iu so that I get only a few eggs in the hope the quality will be better. 
Anyone else ever done this? It sounds to me like mild IVF, which concerns me as we're already up against it with the bad swimmers.

I just wondered what kind of IVF/ICSI treatments/protocols other women with PCO have had and what the docs have told you about it? And what kind of success?

I've never really done anything about my PCO as I just assumed it didn't affect me in any way (other than the fact I have mild acne at times). When I was first diagnosed around 8 years ago, the gyna just told me to keep my weight down and read up about it on the internet! I kept my weight down and forgot about it!
I'm now starting to think I should do this whole GI diet thing and treat it like I have the full blown PCOS? And does it really affect our chances that much with ICSI??

Any advice would be much appreciated!

Thanks
x


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## Roo21

Hi Lou...you sound like me! 

We did icsi as DH had few swimmers and after our 2nd failure I was diagnosed with ovulatory PCO. The only indicator for it was that I responded too well to Gonal F for my age and I was found to be insulin resistant... I too was told that could be affecting my eggs. As a result if this i was given metformin to take a month before my cycle to counteract the insulin resistance, started a low GI diet and took Clexane fom egg collection. 

The thing that i think really swung it for us though was CGH (chromosome testing) at Day 3 or 5. Out of 8 embryos only 2 were normal and one stuck. I still cant believe how lucky we are, but I really believe that without the CGH we would never have gotten pregnant..... That said, Im also older, and have endo and adenomyosis, so those things did't help either...It is expensive and not everyone needs it, but it definitely worth looking into.

I really hope that you next cycle works for you and you find some answers, I know how frustrating and heartbreaking the whole process can be. Happy to answer and questions if you have them!

Xx.


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## Lou32

Thanks for your reply. I've read so much that Metformin is recommended with PCO ladies - I can't understand why my consultant hasn't suggested it for me. Do you mind me asking how you were diagnosed with insulin resistance? I asked my GP to test me and she did a fasting glucose test, which came back normal, but I've read loads on the internet that glucose can be normal and you can still be insulin resistant. It's all so confusing!


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## Roo21

Yep! I went privately to have tests after an early miscarriage and got a specific insulin resistance test. I'm not sure GPs do that one. I asked for it to be redone in early pregnancy after I came off the metformin and the GP refused and gave me a fadting glucose instead:growlmad:Funnily enough my fasting glucose has always been totally normal too... still is even though I've now got gestational diabetes, but you're right, it didn't mean I didn't have a problem.


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## Lou32

Hmm, I have an appointment with my GP tomorrow so I'm going to ask to be referred I think. Not sure if I need to see a gynaecologist or an endocrinologist, but will ask anyway.
Thanks again and all the best with your pregnancy xxx


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## JaniceT

Hi, I have mild PCOS, only seen on my ultrasound scans and blood tests. My period is regular, I am not overweight at all, no extra hair growth. And yes, egg quality drops when one has PCOS. It is said that PCOSers get better quality eggs with the short protocol, which I will use the next time round.

My first two tries with ICSI at fertility clinic A (let's call it that) failed. I was on long protocol, no frozen embies. Averaged 30 mature eggs each time. Fertilized almost all, only 3 embies made it to Day 2 each time for a Day 2 transfer. BFN.

My 3rd ICSI cycle, I changed clinics. My new doctor was excellent. He put me on Metformin to see if it could help control my PCOS. Although he kept me on long protocol, I was on the lowest stims. 150 dropped to even lower. I still got about 29 eggs. Fertilized almost all, only 4 made it to Day 3 for transfer, none frozen. We transferred all 4 seeing that I am past 35 years old and it's my 3rd attempt. I got a BFP! My baby is now 7 months old.

I wasn't diagnosed with insulin resistance but my hormone blood test showed I had levels above normal. Added with PCOS, he suggested Metformin.

Do not give up!! Ask your doc about Metformin, or at least discuss if you should be on it.


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## Lou32

Thanks for your reply too - it really makes me think I might be on to something here and I'm certainly going to be asking for the Metformin! I saw my GP this morning and asked him about going on it now, or if he'd refer me to an endocrinoligist. He said he would refer me, but he would only refer me to a gynaecologist. I suppose I'll have to see what this doc says. We're planning to start our third ICSI in January, so I'd like to get this thing under control by then and be armed with as many facts as poss before I see the fertility consultant for our next ICSI and tell him, now look here, I want that Metformin for this cycle!
I've been on this low GI diet now for a month (with a short break in the middle when we went on hols and I cheated) and I've defintely had increased progesterone this cycle. I don't know if it's still the after-effects of the failed ICSI cycle still, but I can't help but think it might be the diet.


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## googoo

i am also wondering this as i have pco and all bein bell shud be cycling in august for icsi xx
can anyone post how many follies retreived and fertilised plz xx


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## Lou32

Hi - just replied on your other thread. Just wanted to add though that I wouldn't read too much into the follicle number - it's impossible to say how many eggs you'll get from the follicles you can see on the ultrasound.


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## Beans28

As the other women said here, Metformin is very important. My dose was to low during my first two IVF cycles and I got a :bfn: each time. 

I was told a good indication (but no replacement for a bloodtest) is if the lower part of your face breaks out. This usually means your angrogynous hormones are off. 

my third cycle, I did a gluten free diet (paleo diet) and my RE doubled my metformin and we were successful. 

Best of luck!


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## _Nell

Hope it's ok to ask a Q on this thread, my Dr has told me this morning I have polycystic ovaries too (antral follicle count of 27 and apparently more than 12 on an ovary is poly cystic) but i don't have PCOS - how is that? I'm confused.

I have low amh, so I need high stimms but i do get a good number of eggs (24 and 16 on my 2 IVF's)....however no BFP so maybe i have quality issues too.

Lou - I'm a bit confused on polycystic ovaries but not PCOS and I see you've mentioned similar. Should i be taking some meds for this too :wacko:

Seriously, is there any fertility issue i DON'T have going on :coffee:


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## Lou32

Hi Nell - We seem to be following each other about on these threads with our 'problems'! (I was surprised to read I wasn't the only one suffering from IC the other day. I thought I was the only one in the world who was going through IVF with that awful condition).
Anyway, re PCO and PCOS, I was diagnosed with polycystic ovaries about five years ago, but my hormone tests came back normal, and becaue I have a regular period and appear to ovulate, the gyna said she thought I have ovaries with multiple cysts (so polycystic ovaries) but I didn't have the syndrome because my hormones were normal. She told me if I kept my weight down it wouldn't affect my fertility. She said if I put on weight, I might get the syndrome and some of the horrible symptoms of it.
Anyway, I actually think this is rubbish as I already suffer from acne (which is a symptom of PCOS) and although I'm not much overweight (BMI around 26 or 27) I find it IMPOSSIBLE to lose weight (another symptom, as many women with PCOS are insulin resistant). However, she offered no treatment because my hormones were normal and sent me on my way.

Only after two failed IVFs am I told that polycystic ovaries can mean poor quality eggs (the more eggs you produce the worst the quality) and there's a higher chance of miscarriage. I've done loads of research on Fertilityfriends and lots of ladies on there who have PCO but not the syndrome (so what you and I have) are put on Metformin. This drug appears to have some nasty side effects, but it helps improve egg quality during IVF and lessens the chance of miscarriage. 
It also appears to help with acne and losing weight if you're insulin resistant (I think). I really think I'm insulin resistant, but of course no doctor has bothered to test me for this. 
From what I've since read, regular exercise and a low GI diet can really help. I think this has helped me a lot the past month or so, but it's not enough.

I've actually asked me GP to refer me to a new gyna who will give me some solid advice on this condition, because none of them have in the past. I'm going to ask why I've not been put on Metformin. However, I've been around the houses and been referred back to my fertility specialist instead. Hoping he'll put me on this drug, as it sounds like it's worth a shot.

Sorry to ramble on, but this is pretty much the extent of what I know.

I can't understand why you need high stimms if you have a high follicle count? I thought that meant they put you on low stimms. 
Ive no idea what my AMH is as never been tested.
Do you have normal LH and FSH? (I think if those are out it can be an indicator of the syndrome)


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## _Nell

Thanks Lou that explains a lot, the Dr yesterday said the same as yours, i have PCO but not PCOS as my hormones are ok (my testosterone is in range and my LH isn't higher than my FSH and i have regular, but short cycles).
I'm pretty sure i don't have PCOS because i think women with PCOSstimulate easily and i need a heap of drugs to produce my eggs.
I'm slim (size 10) but i do get the odd spot around my chin/jawline these were worse when i came off the BCP but are settling down now.

Re my high follicle count / low amh - that's exactly what I asked yesterday, they basically contradict each other. The Dr said this is perhaps an explanation for my poor egg reserve, basically my body is using up twice as many follicles each cycle as it needs to so i've used up my egg reserve faster. He thinks sometimes soon i'll see a massive decline in my follicle count.

Urgh at the idea of more drugs tbh, I'm just not sure i can keep embracing all this new cr*p to put in my body tbh, I worry at the end of this there'll be no baby and a screwed up me. I'm just getting to grips with the idea of steroids and clexane.

Not sure what to do with this for me just yet, will look into the metformin and see if it's something i would take if i could find a gynae to prescribe.


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## dreamofabean

Hi, 
I was told that I have multicystic ovaries at Ivf scans too. Apparently in pcos the cysts are around the edge if the ovary and that's what stops ovulation etc. My cysts were all over the ovaries rather than in one specific area, hence multiple cystic. I don't take any meds, they just have to be careful with ohss with me x


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## Lou32

dreamofabean said:


> Hi,
> I was told that I have multicystic ovaries at Ivf scans too. Apparently in pcos the cysts are around the edge if the ovary and that's what stops ovulation etc. My cysts were all over the ovaries rather than in one specific area, hence multiple cystic. I don't take any meds, they just have to be careful with ohss with me x

That's really interesting, because my last clinic also said I had multi-cystic ovaries rather than polycystic. When I went to my next (and current clinic) I told them what the last nurse had said and they said multi-cystic and polycystic are basically the same and just different docs and nurses use different terms. What you say would make sense though, as my ovulation doesn't appear to be affected...I might ask them that next time I go for a scan.

Just wanted to update that my consultant prescribed me Metformin today. He put me on 500mg three times a day.
What he said surprised me though. He said the reason he hasn't put me on it before is because they've tried PCO and PCOS women on Metformin before with IVF and it makes absolutely no difference whatsoever. I told him that I'd read loads about it improving egg quality, reducing the chance of OHSS etc and that it can also help with acne and losing weight. He said they tried it and it didn't help at all. 
How can this be when there's an army of women out ther (many on Fertilityfriend!) who say it helped?
Felt a bit deflated tbh, but as I insisted I at least try it, he prescribed it anyway.

Would love to hear of other people's experiences.

PS - Only problem is it says you can't drink while on it! I've only just started drinking again after 18 months off the booze due to other medical problems. I'm gutted!


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## _Nell

Glad you've got the meds to try Lou, I hope you do ok with the side effects.

I really want to thak you for this thread, it's come at just the right time for me and without it i think i;d have just overlooked my Dr's comments on my PCO.
I've decided i'm going to ask about metformin for me too and will make a gynae appointment after this current ivf cycle to see what they think - but I know bloods don't confirm it already.
I have overstimulated again and i honestly don't think i need the 300iu of gonal f i'm being given, I think my low amh is a red herring and probably related to my crappy egg quality. I have 27 follicles on my right ovary, with half a dozen at over 22mm.
I read in Dr Beers book yesterday that PCOS can be related to lining problems too - which I have (7mm and 6mm on my ivf's).

I think i've reached the end of the line for me now with IVF unless the gynae feels I maybe do have pcos and meds would improve my egg quality and lining.


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## Lou32

I'm sorry to hear that Nell.IVF is hard enough without the complication and pain of OHSS. I'm no doctor, but it does sound like you're on a high dose for someone with PCO. I don't understand why they don't start you low and increase it if they need to. Surely that's what the monitoring scans are for. Maybe you need a second opinion or new clinic. It sounds like you're almost blaming yourself when it's the clinic which hasn't quite got it right for you. I think meds dosage makes such a huge difference and can mean difference between a BFN or BFP. I really hope they can get it right for you. My doc is reducing my gon F to below 150iu next time as he said 21 eggs was too many. Let me know how you get on Nell. BTW, no side effects with metformim so far!


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## cvaeh

Hi

I was hoping someone may be able to answer me some questions. 

I have just started bleeding 7 days after my transfer. I only had one out of 5 eggs fertilize and the first time with straight IVF I got 0. I am thinking it is an egg quality issue. I was told I did not have PCOS as my blood levels were fine and when they scanned me did not see anything. However I am plagued with acne and do not seem to have a proper natural luteal phase? Does this sound like PCOS?


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## _Nell

Lou- I'm honestly not blaming myself at all, i'm furious with my clinic....I push them every step of the way but ultimately once a cycle starts i only see a nurse and all i get is fluffy reassuring responses rather than genuine discussion about how things are going and any adjustments needed. They haven't adjusted my meds on any of my 3 cycles, it's the very definition of insanity....doing the same thing but expecting different results. This cycle i've had just 2 scans (no bloods), one on day 7 of stimms and one on day 10,it's conveyor belt ivf - great for the average patient but not for me. 
I'm not sure we'll do round 4, it'll depend what the gynae thinks - if we do it will be elsewhere where they're happy to take my money for extra monitoring and where i get to speak with consultants if things go squiffy.

Cvaeh - I'm sorry you've had poor fertilization again, I remember your first round as I too was in a similar situation then. I suppose it could be a response to your protocol, what meds/dose are you using and trigger? It doesn't sound like PCO purely from the lower follicle count, but it's all new to me tbh. 
When you say bleeding 7 days post transfer, is that a 3 day transfer so 10dpo equivalent? That would be about the time the corpus luteums could break down and AF can start to break through your supplemented progesterone, it happened to me on my first 2 cycles. I will be trying a different type of progesterone this cycle (if i go to transfer) but i'm told it's not a problem because if the embryo had implanted that would have boosted your progesterone anyway....although i must say like you i just didn't feel it had a chance and would have felt better with no bleed before OTD.


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## cvaeh

Hi

it was after a two day transfer so your righy in saying it is probably when it starts to break down. did they make you carry on with the pesssries after you had started bleeding.

my first cycle i responded too fast to the drugs and second time i had 9 eggs but only 5 mature ones.

the reason i thought i may have polycystic ovaries was i have acne, lots of facial hair and body hair and i seem to loose a lot of hair in the shower.

thanks for help xx


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## _Nell

I think pcos is loosely defined as poly cystic ovaries + one other symptom - so the hirtuism could be an indicator but you'd need to have the multi cystic ovaries too definitely worth speaking to your Dr about too (I also have excess hair and spots)

Yes they did tell me to carry on with the pessaries, I did to 12dpo then stopped (against clinic afvise). It was ridiculous I had full on heavy AF, negative hpt's and there i was attempting to insert a pessary. It just added to my upset tbh. 
I respond too fast to the meds too.


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## Lou32

Cvaeh - I seem to remember reading somewhere that some women have symptoms of PCOS without the cysts. I think it's worth pushing for tests maybe as it sounds hormonal......Just wanted to add that I tend to start AF early too. I only got to day 8 last time before strong AF pains started. Nell - what progesterone are you planning to go on? I insisted on the bum injection for next time. My doc didn't want to put me on it and told me horrible stories about it but ultimately agreed to shut me up. I think he does that a lot! Kind of dreading it tbh.


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## cvaeh

Hi lou

thats really interesting to hear you can have it without the cysts. are the injections supposed to stop af coming early. did you continue with the progesterone pessaries when your af came. my clinic told me to continue but af is obviously here just a bit lighter. in a normal cycle is your luteal phase short. mine is between ten and twelve days which they keep telling me is okay. i don't think an embryo will ever implant unless i can find a way of extending the progesterone. what protocol have you been doing? thanks for your help x


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## Lou32

From what I've read, the injections are more effective than the pessaries. I kept telling my clinic that Cyclogest didn't do it for me but the didn't believe me. I would have come on around 8 or 9 dp ec last time if I didn't start using natural progesterone cream. It was a gamble but my AF pains went. Yes, i continued with the pessaries til day before OTD. In a normal cycle, my luteal phase is around 12 days but I usually start spotting 2 or 3 days before AF. I've been on SP both times.


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## _Nell

Hmm my luteal phase is around 12 days and I spot from about 4dpo. I'm pretty sure my spotting would affect implantation as it's so early (crappy corpus luteums) but everything i've read says once you make it past 7dpo with no spotting you're ok, as soon as the embryo starts to implant it would start to produce it would signal the corpus luteum to hang around and give of more progesterone.
The pre AF bleeding on an IVF cycle would be the same, the corpus luteums start to break down and the sudden drop brings on the spotting/AF....you're still getting progesterone from your suppositaries but the drop of your natural progesterone means AF starts - I asked my Dr about this because i couldn't fathom that there would be corpus luteums with ivf but apparently with a hcg trigger there are :shrug:

Re progesterone, I read a study that showed crinone gel is as effective as PIO shots, but better tolerated (ie no sore butt!) - have you tried those Lou?
I used crinone my first 2 cycles but AF broke through but no spotting like on a natural cycle.
Using cylogest this cycle if i get that far.

That said the US clinics commonly seem to use PIO shots.


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## Lou32

My acupuncturist swears she's read research which says the natural progesterone cream (must be bio identical) is better than the shots too. For some reason my doc ruled out crinone but can't remember why. My clinic stop listening when I even bring up the subject now so I figured I'd give the shots a go this time....Well I started spotting today. I think I'm around 9 dpo. I predict AF will come about Tues, so that would give me an even shorter LP than I thought, of around 10 days....Interesting about the corpus luteum.


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## fnjightu

this is somthing iv always wondered,,, wheather egg quality is poop with pcos ladies x


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## _Nell

Can I ask about the metformin, is that ordinarily taken by pcos women who don't ovulate (I think i do although it's considered 'weak').

Lou - will you take it from here on until a BFP? or is it like clomid and you try it for a while? Do you take it through IVF - on another forum there's a lady who's just taking it on her ivf cycle.

I had 30 eggs collected today, not sure how many will be immature yet but i really don't think this is normal and am definitely going to discuss metformin.

Does anyone have any useful links for info to read (rather than me blindly googling)


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## Lou32

Hi Nell, I think it's something you take long term rather than a few cycles (like with clomid). I'm not taking it for ovulation as I have regular cycles and I think I usually ovulate (altho had a couple cycles since my last ivf where I'm not sure). Yes, I hope to take it through my next IVF as I've read it can improve egg quality and reduce the chance of OHSS. That said, my doc says he's tried it with lots of ladies and it doesn't. I'm REALLY hoping it will help me lose weight too. I have a BMI of 27 and want to get to 25. I'm afraid I haven't found any great sites for info yet. Random Googling seems to show that met works for many women but not all.... Wow! 30 eggs! Let us know how you get on and I'll keep everything crossed for you xxx


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## Lou32

Sorry, forgot to say that I have lurked around the PCOS section of Fertilityfriends and there's some useful info on there from women who have 'mild' PCOS which I suppose is what we may have?


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## JaniceT

I have mild PCO, no cysts, nadda. Only detectable through my blood test. I just got my scan, have 49 follicles due to PCO on very low stims.


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## RGN

Just thought I'd chime in on my experience with egg quality. I have PCOS, don't have regular cycles, don't ovulate on my own, classic 'string of pearls' cysts, LH 5x higher than FSH, etc. I'm not over weight and have a normal BMI.

I'm on 1500 mg. of metformin daily and have been for almost two years.

I've been able to get pregnant in the past with clomid or femara but have had 3 miscarriages. My RE suspected egg quality issues so we did IVF in order to be able to do preimplanation genetic screening. 

I took 100 iu Follistim and 75 menopur for 6 days and then quit the Follistim all together and just used menopur and ganirellix. I triggered with Lupron. Toward the end they could see 100+ follicles, ranging in size.

They ended up collecting 57 eggs, 33 of which were mature and fertilized. Of those, 12 made it to day 5 blasts. The genetic screening results came back and 10 of the 12 embryos are chromosomally normal. 

I got pretty bad OHSS (gained 17 pounds of fluid in my abdomen) and so had to freeze all and will do a FET next month. 

For me, egg quality wasn't the issue. We'll be treating my blood clotting disorder even more aggressively next time and hope for the best.


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## Lou32

57 eggs!! OMG! That has to be a record? It sounds like you have a good number to go at though with 10 left. I'm wondering if we should go for PGD if we get another dreaded BFN...trying not to think about it.


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## Please

Girls I found this blog solely for PCO - i am loving reading all the advice. Thought it may help others.
https://www.incyst.com/
INCYST ON THE BEST!A NETWORK OF INDEPENDENT PROFESSIONALS COMMITTED TO HELPING WOMEN WITH POLYCYSTIC OVARY SYNDROME. IN ADDITION TO OUR PRACTICES, WE MAINTAIN THIS BLOG AND CONDUCT LOCAL EVENTS. OUR RESEARCH INSTITUTE OFFICE IS IN SANTA MONICA, CALIFORNIA. 


https://www.incyst.com


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## Lou32

V interesting! I already take ZW vital DHD so looks like that's a good thing.....BTW, thinking of reducing the Metformin for a bit. I felt ok at first but the last week I've been feeling constantly queasy. Never knew before that it was possible to feel hungry, bloated and queasy all at the same time. I just can't stomach certain foods. It's given me a seriously strange appetite. I can't stomach anything bland and I keep craving Chinese LOL! If I wasn't 100% sure that I wasn't pregnant I'd be doing a test! Any idea if this sickie feeling gets any better?? Contrary to what many say on tinternet, it's not carbs as I'm doing low carb.


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## Please

Lou when I started metformin I did one tablet for a week (no bother) then two for a week (suffered with heartburn/indigestion a bit) then three for a week (well actually I never made it to a week, the indigestion/heartburn was to much) so I dropped back down to two and all symptoms went. How many are you taking? I just started mine again after a couple of months break, so will repeat the above pattern. Are you taken one at a time at different times throughout the day with food? X


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## Lou32

Yep, I'm taking 3 x 500mg. I take one with brekkie, one with lunch and last with dinner. I did work up to it gradually but over a week rather than weeks. I missed the lunch tab 2day as I felt so sickly and bloated.


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## chaofellfan

I've read so much that Metformin is recommended with PCO ladies - I can't understand why my consultant hasn't suggested it for me. Do you mind me asking how you were diagnosed with insulin resistance?


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## Lou32

chaofellfan said:


> I've read so much that Metformin is recommended with PCO ladies - I can't understand why my consultant hasn't suggested it for me. Do you mind me asking how you were diagnosed with insulin resistance?

Hi, I was in the same position as you and kept reading about it. I asked my consultant why he'd not put me on it and it's cos I ovulate on my own and he said it made no difference to IVF outcomes. I told him I wanted to try it anyway and he said there was no harm so he gave me prescription to shut me up! I've never been diagnosed with insulin resistance.


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