:PCOS & Role of ISD: - Insulin Sensitizing Drugs Insulin
Sensitizers Agents (ISA) .
Q.1:
Prevalence of IR amongst PCOS women ?: Not all
declared and diagnosed as PCOS At least in fair number of PCOS do not exhibit
IR. In fact IR is demonstrable in 70-80% in obese women and 20-30% of nonobese
PCOS women. Prevailing IR in PCOS is possibly obesity oriented. But those who
exhibit hyperinsulinaemia increase the ovarian androgen production .Therefore,
impaired oocyte quality.
Q.2:
Should Metformin be used only in obese PCOS? : - For
lean Pcos metformin alone can be tried for ovulation induction. But in obese
women so far as OI is concerned metformin as solo therapy yields poor results
.Therefore one should always add CC/HMG. But so far as live birth rate is concerned
in obese women
there is no added benefit of CC or hMG and addition of Metformin.
Q.3:-What
about Metformin in IVF programme? Concurrent Metformin therapy allows
reduction of OHSS prevalence.
Q.4.
Metformin in Pregnancy-Safety issues? Ans: Metformin can be safely used in pregnancy.
Q.5: In which cases Metformin do not exert any
beneficial effect? Ans: In following cases Metformin do not exert
any beneficial effect and therefore
should not be used:-1) Hirsutism .2) Acne. 3) Long term prevention of CAD/ T2D in PCOS
women.3) obese PCOS women along with CC/ hMG-addition of met does not prevent
abortion.
Q.6. Mode of action of
Metformin ? :-Ans; ‘Metformin mainly
lowers the fasting insulin, though the insulin lowering effect is not identical
for all men & women.
Q.7: How useful in lean
PCOS? : -It seems paradoxical that
metformin is possibly more effective
than obese PCOS women.
Q.8. How effective in
regularising the cycles?-
In this regard, OCP will be a better
choice though Metformin may be used. One should add Vit B12 if more than 6
months met therapy: - Side effects –Bothersome in as many as 30% of cases.
Q,9:
Does Pre-treatment with met helps prior to OI: - No final word. Possibly not. From: Dr L Pal Book on PCOS
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