Fertility problems are frustrating and heartbreaking. You may have heard of metformin if you’re looking for ways to deal with infertility. It is also used to help women get pregnant. Metformin can be an effective medication for certain fertility issues, but it is not for everyone.

We asked fertility experts for their help in understanding what metformin was, how it could help with fertility and who would be a good candidate to take it. They also gave us some questions you can ask your healthcare provider to learn more.

What is Metformin?

Alex Robles, MD, OB/GYN, and reproductive endocrinologist, Columbia University Fertility Centre, explains that Metformin, a common oral medication used to treat diabetes. He says that metformin works by decreasing the production of glucose in the liver, and increasing insulin resistance. Metformin, in combination with other medications can help women with Polycistic Ovarian Syndrome (PCOS), especially if they show signs of insulin resistance.

According to Centers for Disease Control and Prevention, insulin resistance is a disease where your cells don’t respond to insulin well. This can lead to unhealthy levels of glucose building up. It can lead to diabetes. PCOS can cause insulin resistance and fertility problems.

How can you tell if you are insulin resistant? Many people who do not have diabetes, or even pre-diabetes, can develop insulin resistance, says Suzanne Bovone of Obstetrics and Gynecology of San Jose. This can be determined by measuring fasting blood sugar and insulin levels.

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Metformin and Fertility: Does it Work?

Dr. Robles says that Metformin is not usually prescribed to treat infertility alone. He explains that Metformin is not a fertility drug by itself. It can, however, be combined with other medications in order to treat PCOS patients who do not have regular periods and are not ovulating. If you’re responding well to metformin and your doctor recommends complementary medications such as letrozole or clomid to improve ovulation, then Dr. Bovone suggests that they may be recommended by your doctor.

PCOS can affect between 6 and 12% of women born as girls. It is characterized by irregular periods, ovulation issues, and an excess of facial and body hair. PCOS can also lead to small ovarian tumors.

Metformin is good for whom?

Metformin has been approved by the FDA for people with type 2 diabetics and insulin resistance. It is intended to be taken along with diet and physical activity to lower blood sugar levels and improve the way the body reacts to insulin. 3

Dr. Robles says that it is only appropriate to use metformin during pregnancy in specific situations. Dr. Robles says that he only recommends metformin to people who are having difficulty conceiving and have PCOS or insulin resistance.

Dr. Bovone is in agreement with this recommendation. She explains that by lowering glucose levels and improving the insulin’s effects on cell metabolism, reproductive hormonal signals can better signal each other to allow ovulation resume. “Metformin does not help with fertility in those without PCOS or insulin resistance.”

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Metformin side effects and risks

Metformin’s most common side effects are gastrointestinal. These include nausea, diarrhea and stomach pains. Dr. Bovone suggests that side effects can be minimized by beginning with a small dose and gradually increasing it over time. She also explains there are different formulations for metformin including liquids or tablets. Liquid metformin is generally better tolerated.

Metformin may have severe side effects in rare cases. Dr. Bovone says that the most serious side effect is lactic acidosis. Therefore, metformin shouldn’t be used for severe systemic infections (sepsis), renal insufficiency or heart failure. The Journal of Assisted Reproduction and Genetics published a review in 2022 that found taking metformin to improve fertility doesn’t negatively affect fetal development. However, the long-term effects of metformin on infants are unknown.

What to ask your healthcare provider

Your overall medical history will determine whether or not a doctor will prescribe metformin to treat your fertility problems. First, you need to make sure that you are eligible for metformin.

Dr. Bovone says that if you’re interested in taking metformin you should first confirm with your doctor that you have PCOS. She says that if all other tests come back normal and I suspect PCOS, with insulin resistance, I will prescribe metformin. She starts her patients with a low dosage and gradually increases it to reduce side effects. Over a few weeks, we will see if weight loss is occurring and if ovulation improves.

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Dr. Robles suggests discussing the pros, cons and possible side effects of the medication with your fertility doctor. Metformin is a useful medication for those with PCOS or insulin resistance. However, even then, it may not be for everyone. It’s important to have an honest and open discussion with your doctor before deciding if metformin will be the best fertility medication.