PATIENT INFORMATION SHEET – METFORMIN Metformin is a medication used for treatment of the symptoms of polycystic ovaries. It has been used for 40 years in the treatment of some types of diabetes. It works by reducing the insulin resistance of the ovaries in polycystic ovary syndrome (PCOS). Metformin may improve the quality of the eggs and the pregnancy rate in women with polycystic ovaries having IVF treatment. It does not affect the number of follicles or the fertilisation rates, but may reduce the risk of ovarian hyperstimulation syndrome. If used for several months it can improve any symptoms of excess hair, acne and irregular periods. Taking your tablets If you can it is best to start the tablets in advance of your IVF treatment cycle; it can take time to become used to them. However, benefits for your treatment will still be seen if you start the tablets at the same time as your IVF drugs (Day 19). In the initial stages you may get symptoms of nausea, diarrhoea and abdominal bloating but your body wil become used to the tablets. If you do get these symptoms reduce the number of tablets you take until the symptoms disappear and then increase the dose more gradually. The full dose may be too high for you but benefits wil be seen even if you are on only one or two tablets a day. Starting Metformin Prior to IVF Treatment
• Take the tablets after a meal • For the first week take one tablet after the evening meal • In the second week increase the dose by taking one tablet after breakfast and one tablet
• In the third week take three tablets a day IF you are able to tolerate the effects. Take the
• Continue on three tablets a day through the IVF treatment
Starting Metformin at the Day 19 Appointment If you start Metformin at the day 19 appointment you wil need to increase the dose of tablets more rapidly:
• Start the tablets as soon as you can after the day 19 appointment • Start on one tablet a day after the evening meal • After 5 days increase the dose to two tablets a day • After a further 5 days increase the dose to three tablets a day if you are able to tolerate the
• Continue on three tablets a day throughout the IVF treatment.
Reasons to Stop Metformin If you develop ovarian hyper-stimulation syndrome from your IVF treatment you should stop Metformin. It should also be stopped if you have a severe infection or require emergency surgery. If you become pregnant you should slowly reduce the number of tablets you take over the first two weeks. Stop the tablets completely by 6 weeks of pregnancy (two weeks after a positive result). If you stop the tablets suddenly there is a higher risk of miscarriage. If you do not become pregnant and wish to continue the Metformin you can do so. It is used for the treatment of PCOS and can be taken indefinitely.
Author: C.Gladwell Approver: S.Ingamells
PRURITO MVZ ESP. Escobedo Straffon Jorge Luis Dermatología de perros y gatos Hospital Veterinario de Perros, gatos y Fauna Silvestre de la UPAEP. Hospital Veterinario de Especialidades los Ángeles. Puebla, Puebla DEFINICIÓN El prurito es un síntoma preocupante, que además de causar molestias, pone en peligro la eficacia de la piel como barrera de protección, es de los síntomas más comunes
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