Q: I am in my 8th week of pregnancy. We had an IUI done. This is my first pregnancy. I was given metformin before my pregnancy for few months to regulate my periods. I guess I have slight PCOS too. Now, during my pregnancy my gynaecologist has asked me to stop metformin. I am on Microgest Progesterone Softgel now for twice a day, Pregnyl 5000 IU injection twice a week, 5mg folic acid once a day. I have to take all these for a month and then go and see my gynaecologist. Will there be any harm if I don't take Metformin now? What are the side effects of these medicines? How often should I go for my sonography? What food should I eat and what should I avoid? What should be my sleeping position?

A:In cases of established Polycystic Ovarian Syndrome (PCOS), metformin is indicated till conception. Hence there is no further need to take this medicine once pregnancy has been established. Human chorionic gonadotrophin (hCG; sold under several trade names such as Pregnyl, Corion, Pubergen, Profasi etc) is indicated in IVF induction, corpus luteum deficiency, habitual abortion and infertility to ovarian dysfunction. Its side effects include: oedema, ovarian hyperstimulation or enlargement, ovarian cyst rupture, water effusion in abdomen or lungs, clotting in the blood vessels, depression etc. Progesterone (such as Microgest) is approved for use in the prevention of endometrial (inner lining of uterus) hyperplasia in postmenopausal women who are also receiving oestrogens. It is also used in amenorrhoea (absence of menstruation) due to secondary reasons. It is not to be used during pregnancy. Rare cases of defects such as cleft palate, cleft lip, heart defects have been reported in infants born to women taking progesterone during early pregnancy. Rare instances of foetal death and spontaneous abortion have been reported in pregnant women prescribed progesterone for unapproved uses. Some progestogens are also implicated in hirsutism (unwanted hair on face) of female foetuses in some cases. The use of progesterone is quite controversial. Internationally, most experts are against its use during pregnancy. Due to aggressive marketing in India, progesterones are being prescribed as if they are tonics. Side effects of progesterones in the women include: venous thrombo-embolism, liver and vision disorders, fluid retention etc.