Metformin—What Is it and Why Is it Used in Fertility Treatment?

Metformin is an insulin-sensitising medicine that helps in reducing the blood sugar levels and also to treat type 2 diabetes. However, the use of metformin is not limited to manage blood sugar levels in people with diabetes. Metformin is also used for the management of olycystic Ovarian Syndrome (PCOS) is a common cause of infertility in women. Metformin can help regulate menstrual cycles in PCOS patients and s the chances of pregnancy in them.

Keep reading to learn more about the uses of metformin and what metformin is.

What Is Metformin?

Metformin is essentially an antidiabetic agent. It is an FDA approved drug that is largely used to treat type 2 diabetes or diabetes mellitus. Metformin is commonly prescribed to patients with type 2 diabetes who don’t observe any positive changes despite lifestyle changes such as improving diet and increasing physical activity. Metformin is suitable for the management of hyperglycaemia or excessively high blood sugar levels in adult patients as well as paediatric patients who are aged 10 years or older.

As of now, metformin is the only antidiabetic medication that can be recommended to people with prediabetes according to the American Diabetes Association (ADA).

Metformin has other use cases as well. Obese women diagnosed with PCOS are usually hyperinsulinemic, that is, they have increased levels of insulin and androgens (male hormones) in their body. Metformin helps to decrease the insulin resistance in PCOS patients.

How Metformin Works?

Metformin belongs to a class of biguanide drugs, and it is effective in lowering blood glucose levels by the following ways:

• Reducing glucose production in the liver
• Decreasing absorption of glucose in the intestines
• Enhancing insulin sensitivity

*Insulin is a hormone produced by your pancreas which is used by the body to utilise glucose as a source of energy.

Metformin activity in the body leads to reduced postprandial (after consuming anything) and basal (overall) blood sugar levels. Metformin is an effective drug in reducing blood sugar levels, but it unlikely to cause hypoglycaemia excessively low levels of blood sugar. It may also have some cardioprotective effects, which is further helpful in the treatment of diabetes.

In women with PCOS, metformin plays a crucial role in the management of the disease by lowering insulin levels, which in turn leads to a reduction in the levels of luteinizing hormone (LH) and androgens. With normalisation of these hormonal levels, menstrual cycles of the affected women can be regularised.

Metformin is recommended as an alternative to insulin for women with gestational diabetes (diabetes developed during pregnancy). This is because hyperglycaemia during pregnancy can be associated with birth defects (or congenital malformations); taking metformin during pregnancy can lower blood sugar levels for women with gestational diabetes. This drug can also be helpful in inducing a modest amount of weight loss.

Usually, metformin takes 3 hours to take affect after being consumed and its half-life (the time it takes for active ingredients of metformin to reduce by half) is 20 hours. This drug exits the body through the kidneys and is mostly unchanged in the body as very small amount of the drug is metabolised in the liver. Thus, renal or kidney function monitoring is crucial when consuming metformin to ensure the treatment is not causing any harm to the patient and is effective.

Types and Forms of Metformin

Metformin tablets are available in both immediate- and extended-release formulations. This drug is available in oral medication of the following concentrations:

• 500 mg oral tablets
• 625 mg oral tablets
• 750 mg oral tablets
• 850 mg oral tablets
• 1000 mg oral tablets
• 500 mg extended-release oral tablets
• 750 mg extended-release oral tablets
• 1000 mg extended-release oral tablets
• Metformin dose of 500 mg/5 mL oral solution

Medical Uses of Metformin

Metformin can be used for the following:

• Fertility treatment
• Addressing weight gain issues caused by antipsychotic medication
• Preventing type 2 diabetes
• Treatment and prevention of polycystic ovary syndrome (PCOS)

Doctors find the use of metformin in fertility treatment effective because it helps in the following way:

Ovulation Induction

Menstrual cycles become regular with Metformin administration and ovulation is induced as a result in some PCOS patients. But doctors prescribe this drug only to insulin-resistant women with PCOS, and not all women diagnosed with PCOS.

Improved Pregnancy Rate

Doctors accept that a combination of Metformin with other fertility drugs improves the pregnancy rates. Injectable gonadotropins combined with metformin may boost the birth rate up to 32-60% in women.

Reduced Risk for Ovarian Hyperstimulation Syndrome

Administration of fertility drugs increases the risk of Ovarian Hyperstimulation Syndrome (OHSS), especially during IVF treatment. And women having PCOS are at greater risk of developing OHSS. According to studies, metformin can reduce the risk of OHSS for a person who is going through IVF treatment.

Reduced Risk of Repeated Miscarriage in Women With PCOS

Women having PCOS experience a greater number of miscarriages than others. According to researchers, metformin may reduce the risk of miscarriage in women diagnosed with PCOS.

Management of Gestational Diabetes

Metformin is used for treating gestational diabetes as an alternative to insulin therapy if non-compliance or other technical challenges occur with insulin. Insulin therapy may also be combined with metformin administration to achieve ideal blood sugar levels in pregnant women with gestational diabetes if needed.

Researchers are currently evaluating metformin for its potential anti-aging, anti-cancer, and neuroprotective properties. This indicates to the potential of metformin in the following aspects:

• Reduction in the risk of cancer in people with type 2 diabetes
• Lower chances of dementia and stroke
• Prevention of age-related diseases
• Increased lifespan
• Slow aging process

Dosage of Metformin

Metformin is available as an oral medication that is usually prescribed to be consumed daily, and the daily dose can range from 500 mg to 2500 mg. Metformin may cause gastrointestinal (GI) upset if taken on an empty stomach; thus, it is recommended to be consumed with meals. As you know, metformin is available in two forms—immediate-release (recommended twice a day) and extended-release (recommended once a day). If needed, metformin doses for a patient are increased slowly over a week with increments of 500 mg or 850 mg to reduce the risk of side-effects.

Metformin is used as monotherapy treatment in patients with less than 9% HbA1c levels and as a part of combination therapy in patients with higher than 9% HbA1c levels.

Please note that one cannot self-medicate with metformin. Consuming this drug with no or improper guidance can have life-threatening consequences.

Metformin Side-Effects and Risks

Metformin performs about three complex actions to help lower blood sugar levels; consuming this medication may result in the following side-effects.

1. Common Side-Effects of Metformin

Here is a list of the most common side-effects of metformin:

• Diarrhoea
• Nausea
• Headache
• Constipation
• Vomiting
• Bloating
• Gas
• Unexplained fatigue
• Heartburn
• Stomach pain
• Upset stomach
• Unusual sense of taste or metallic taste in the mouth
• Sore throat or other symptoms of the common cold

2. Serious Side-Effects of Metformin

Metformin can potentially lead to the following side-effects in some of the cases:

Severe Allergic Reaction

In some cases, metformin can cause potentially serious allergic reactions. If you notice any of the following after starting metformin, stop using it and consult your doctor immediately:

• Wheezing or difficulty breathing
• Racing heartbeat
• Swollen lymph nodes
• Joint pain
• Difficulty swallowing
• General sense of illness
• Fever
• Stomach cramps
• Dizziness
• Hives or rashes
• Swelling in the face, lips, tongue, or throat

Lactic Acidosis

Lactic acidosis is a potentially serious condition that involves lactic acid buildup in your blood. If you notice any of the lactic acidosis symptoms, such as the ones mentioned below, stop using the medication and talk to your doctor immediately:

• General sense of illness
• Difficulty breathing
• Muscle pain
• Stomach pain
• Drowsiness

Vitamin B12 Deficiency

It is believed that metformin can reduce the absorption of vitamin B12 in some people, which may lead to anaemia. Your doctor may recommend a suitable vitamin supplement when prescribing metformin. However, you must consult with your healthcare provider upon noticing any of the following:

• Extreme fatigue
• Abnormal or fast heartbeat
• Yellowish or pale skin
• Light-headedness or dizziness
• Shortness of breath
• Cold hands and feet

Hypoglycaemia

Hypoglycaemia or low blood sugar may occur when metformin is used with insulin or other antidiabetic medications. If this happens, your doctor will need to adjust the dosage of your medications. Thus, contact your doctor if you notice:

• Anxiety or increased irritability
• Blurry vision
• Slurred speech
• Confusion or dizziness
• Seizures
• Feeling jittery or extremely restless
• Sweating profusely

You are advised to consult with your healthcare provider upon noticing any of the metformin side-effects mentioned above. However, it is possible for a person to experience other side-effects than the ones mentioned above so it is recommended that you talk to your doctor if you think your body may be having any adverse reaction to the medicine.

Precautions of Metformin

Metformin is not a regular over-the-counter medicine that may cause mild side-effects in worst case scenarios. It is an antidiabetic medication that should be consumed only on a doctor’s prescription according to the guidelines specified by the doctor. Metformin use can potentially lead to severe side-effects as well.

Here are a few things to remember while taking metformin:

• Keep the medicine out of reach of children.
• Don’t share your medication with other people with the same condition as it may harm others.
• Use an accurate measuring device if you take oral solution of metformin to avoid taking the wrong dosage.
• You may notice something resembling the metformin tablet in your stool (or poop), which is completely normal.
• Avoid cutting or breaking extended-release metformin formulation tablets
• It can increase the chances of pregnancy for females who have started menstruating and who haven’t gone through menopause.
• Metformin administration is supposed to be done at the same time every day.

The following groups of people are recommended not to take metformin tablets:

1. People With Certain Allergies

People who are allergic to any of the following are advised against taking metformin:

• Metformin
• Fortamet
• Glumetza
• Any ingredient mentioned on the product label

2. People With Kidney Problems

If your kidneys aren’t functioning properly, metformin should be avoided. Before recommending metformin, your doctor will likely order a kidney function test.

3. People With Metabolic Acidosis (Including Diabetic Ketoacidosis)

People who have acute or chronic metabolic acidosis are not suitable candidates for metformin tablets. If you have experienced metabolic acidosis or diabetic ketoacidosis, tell your doctor in advance.

Additionally, it is best to inform your doctor about the following if they are thinking of prescribing or have prescribed you metformin:

• Liver problems
• Pre-existing diseases
• Complete medical history
• Current medication and supplements
• Breastfeeding
• Pregnancy

Summary

Metformin is a readily available, inexpensive medication that is a first-line treatment for type 2 diabetes. However, its use case is not limited to hyperglycaemia.

Doctors recommend metformin for PCOS, pregnancy, and fertility issues because of its effect on the female reproductive system. According to ADA, metformin is a safe and affordable medication that is effective, and it may also lower the risk of cardiovascular issues.

Metformin may not be a cure-for-all, but it is certainly effective in fertility treatments. If you have any doubts about metformin or how to take it, consult with a fertility specialist at a leading fertility clinic in India—Nova IVF Fertility—by booking an appointment online.

FAQs About Metformin

How should metformin be stored?

It is best to store metformin in a cool, dry place usually at room temperature (i.e. between 20°C and 25 °C). Metformin may be exposed to temperatures ranging from 15°C to 30°C for shorter periods of time for transportation without causing any problems with its efficacy.

What if I miss my dose of metformin?

You can take the missed dose as soon as you remember you have forgotten. But if it is nearly the time for the next dose, skip the missed dose and continue with your regular schedule of medication. Avoid taking a double dose as this may create more problems.

I have accidentally taken too much metformin; what should I do now?

If you or someone you know have taken more than the recommended dose of metformin, seek medical attention right away as this is a medical emergency. Overdose of metformin can lead to the following symptoms:

• Extremely low blood sugar levels
• Extreme weakness and tiredness
• Reduced appetite
• Abnormal heartbeat (excessively slow or fast)
• Shortness of breath