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Is the use of clomiphene and metformin during pregnancy fine?

Q: My wife, 30 years old, has PCOD. She was on Metformin 500 mg twice daily, folic acid and fertomid 50 mg. She has one follicle measuring 19 mm x 18 mm in the left ovary and 10 mm x 10 mm in the right ovary. She has been prescribed Hucog 5000U injection. Is this size favourable for pregnancy? Since there are 2 follicles are there any chances of twins? What precautions should she take after the Hucog shot?

A:The use of Fertomid (clomiphene citrate) and metformin in PCOD is quite appropriate. Folic acid is to be given to all women wanting to conceive. Hucog is the brand name. It contains human chorionic gonadotrophin (HCG) which is indicated in two conditions (a) assisted reproductive techniques such as in vitro fertilisation (IVF) and (b) anovulatory or subovulatory cases where there is no or inadequate ovulation. It is not possible to assess the need or otherwise of HCG in your case without full history, results of the tests, etc. The chances of multiple pregnancies in your case are slim since there are not that many follicles. However, the use of HCG can result in Ovarian Hyper Stimulation Syndrome (OHSS), since at least one follicle is over 14 mm in diameter.

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