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If your CGM looks insulin-typical (40+ point spikes after rice, prolonged hyperglycemia after dinner), the case for metformin or a GLP-1 before spironolactone gets stronger

Per IVY RX's published safety information, they should be stopped at least two months before attempting to conceive

10.2337/dc11-s227 76

Orlistat in polycystic ovarian syndrome reduces weight with improvement in lipid profile and pregnancy rates

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Were very close
