Optimal Medication Protocols for PCOS during Intrauterine Insemination (IUI)
Reviewing years of research the latest recommendations for the treatment of Polycystic Ovarian Syndrome (PCOS) suggest utilizing lifestyle and dietary changes along with exercise as the first line treatment option. This is a powerful recommendation as many of the hormonal imbalances common to PCOS seem to improve significantly with these changes. Meaning your chances of conceiving naturally can increase as well as if you need to pursue further fertility treatment down the road you may have a better chance of succeeding if you have successfully implemented the above mentioned changes beforehand.
When trying to conceive naturally does not work with dietary & lifestyle changes, exercise, and supplementation one of the next therapies that is recommended is treatment with intrauterine insemination (IUI) while using one of two common medications protocols for PCOS: gonadotropins or clomiphene citrate (CC, or clomid). However, one of the complications with PCOS is that the uterine lining is difficult to thicken.
Ideally the uterine lining should be above 7 mm at the time of insemination for an IUI or for any other fertility treatment. This is a big challenge for many patients with PCOS due to increased baseline inflammation, poor blood flow to the reproductive organs, and poor insulin sensitivity decreasing glucose transport to the cells of the uterine lining.
A recently published (June 2020) study in the peer-reviewed journal "Human Reproduction" found that the above mentioned protocols may work better for PCOS patients depending on their uterine lining thickness. For patients who have failed IUI treatment multiple times and consistently have a uterine lining thickness less than or equal to 7 mm, increased pregnancy rates were observed when switching to a gonadotropin drug protocol instead of using the clomid protocol. However, if the uterine lining is above 7 mm, the clomid protocol seems to have the same success rates as the gonadotropin protocol. Therefore it is recommended to use the clomid protocol when the uterine lining is above 7 mm as it is significantly less costly compared to the gonadotropin medications.
It is important to note that the size of this study was small and more research is needed to see if these differences in success rates based on specific drug protocols for PCOS patients vary depending on the thickness of the uterine lining.
This article is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance.