Q & A Sessions: Polycyctic Ovarian Syndrome
(PCOS)
Our experienced Penn Fertility Care physicians answered
your questions about polycyctic ovarian syndrome
(PCOS).
To learn more, read about the Penn
Polycystic Ovary Syndrome Center.
Jane asks:
I have polycystic ovaries and am 30 years
old. My partner would like to wait
until I'm 35 to have children. Could
it be problematic to wait that long?
Clarisa
Gracia, MD responds:
If you are not releasing an egg every
month, you will most likely need
to take medication to help you achieve
pregnancy. This is true now or at
35. However, we know that fertility
declines after age 35. You may conceive
easily, or it may be difficult. Unfortunately
it is not easy to predict. However,
I would suggest trying sooner than
35 if your life situation permits. |
Sharon asks:
My age is 29. I have been trying to conceive
for two years. My periods were irregular
ever since we planned to start a
family. Later it was diagnosed that
I have polycystic ovarian syndrome.
I tried clomid, intra uterine insemination
two cycles. First cycle was canceled
due to my periods. The second cycle
we had no response.
What would be your suggestion for
me? Should I try one more cycle or
go for laproscopic? My insurance
doesn't cover in vitro fertilization.
What are the chances of me becoming
pregnant with IUI. I have no other
problems.
Kurt
Barnhart, MD responds:
Sharon, there are treatments short
of in vitro fertilization for someone
with polycystic ovaries. The best hope
for you is for someone to go over your
entire history and find out the details
of why your cycle was canceled or why
you did not respond. Sometimes a second
opinion is what is needed to pursue
other options. IVF does have a high
chance of working, but in your case
it may only be needed as a last resort. |
Sally asks:
I am 26 and a half. I have polycyctic ovarian syndrome (PCOS), and I am also
on 0.125 mg of synthroid. My boyfriend and are hoping to start a family in
May. What can I expect as for difficulties. I read that another woman on
synthroid had miscarriages. Is this common?
Clarisa
Gracia, MD responds:
You should simply have your thyroid hormones checked by your physician prior
to pregnancy. If it is well controlled, then you should not be at high-risk for
pregnancy complications. It is important to have your thyroid hormones checked
because thyroid deficiency is associated with miscarriage and developmental problems
in babies born to moms whose thyroid is not under good control. |
1977 asks:
I am 27 and had an abortion when I was 23. After going through severe weight
loss and losing my periods, I got help and have gained my healthy weight
again. I was diagnosed with polycystic ovarian syndrome (PCOS), not because
I'm overweight but because the lining of my ovaries was very thin. I have
been on 4 cycles of 50mg clomophene with no luck but my levels are higher
with every cycle.
We have now been trying for a year
and I am ovulating with great levels
(with help of clomophene and trigger
injections). Why am I not getting pregnant?
Would you recommend IVF for my condition,
or should I give it more time?
Steven
Sondheimer, MD responds:
In general, abortions do not cause an infertility problem. I assume you have
had a complete infertility evaluation including semen analysis and Hysterosalpingogram.
I do not know why you are not conceiving but this is not unusual after 4 cycles
medications.
You may want to talk to your physician
about the following options. One option
could be to see if you ovulate without
medication and conceive spontaneously
for a few more cycles. You can also
discuss with your doctor treatments
for unexplained infertility such as
trying an actively managed cycle of
clomphene citrate monitored with ultrasounds
to confirm a normal uterine lining
and mature follicles, triggered with
HCG then both coitus along with intrauterine
insemination of washed concentrated
sperm.
You may consider trying this
for three cycles before IVF. However,
IVF has the best chance of success
in any one cycle and is an appropriate
choice even at this time. |
Shontel asks:
I am 19 years old and have been told
that I have polycystic
ovary syndrome. I always have
irregular periods and miss one every
other month. I recently went to the
doctor and got birth control that
made my period last for almost a
month and stopped taking them.
At my recent visit I asked the doctor
if there were tests that could be
done to determine if I could even
get pregnant. Her reply was I should
wait until I'm married and settled
to have test done. I have been with
my boyfriend for two years now and
even though we're planning to wait
until we are stable and older to
have children, I have not gotten
pregnant.
Should I wait and have my fertility
evaluated when I am older or does it
benefit me to be tested now to know
what I could be facing?
Steven
Sondheimer, MD responds:
Polycystic ovarian syndrome is one
of the most common reasons why women
have unpredictable vaginal bleeding.
Birth control pills are a safe and
effective way to decrease heavy bleeding
and have other added benefits. Please
discuss the bleeding with your doctor.
Often three months of the pill are
needed before the irregular spotting
becomes less of a problem. If you are
still having bleeding problems discuss
this again with your doctor, often
changing to a different pill will improve
the situation.
Most women with polycystic syndrome
eventually are able to conceive, some
will require medical help. We often
see women with PCOS here at Penn and
would be glad to see you in consultation
or for care. I would agree that as
long as your hormonal levels were checked
that further evaluation, if needed,
should await your attempting pregnancy.
If possible, I suggest couples consider
starting their families when younger.
If you would like to schedule an appointment
with a Penn Fertility Care specialist,
please call 800-789-PENN (7366). You
can also request
an appointment online. |
Meli7138 asks:
I was told I diagnosed with polycystic ovarian syndrome (PCOS) a few years ago.
I wanted to know if there's a surgery that can help someone with PCOS conceive
a child?
Clarisa
Gracia, MD, MSCE responds:
In the past, PCOS was treated with a surgery called ovarian wedge resection.
Now, PCOS is usually treated with medication to enhance fertility, or to treat
symptoms. Rarely, a procedure called laparoscopic ovarian drilling can be performed
in patients with very unusual problems.
We would be happy to provide a fertility
evaluation and treatment recommendation
to you. To make an appointment call
1-800-789-PENN or you can request
an appointment online. |
Shellie25 asks:
Please, please help me. I don't know what to do. I had a ultrasound scan in August
2006 which showed suggestive PCOS, however, when i went to my appointment
with the fertility nurse (consultation) she was very abrupt and said that
I didn't have PCOS I was just fat and that's why my periods were irregular.
I have an appointment for St Barts (London) but she said unless I get my
body mass down from 35 to 32 in four months they will turn me away.
Is this true that a clinic would
turn one away for their weight? I
don't want to go and face the heartbreak
of being told I cannot have the treatment
as this is hard enough. Also, I don't
know if you can comment on this but
I had unprotected sex with my boyfriend
two days after my period was due
14th Oct 06 and started bleeding
early hours of the morning. It's
now been a day and I'm just about
off my period. I have sore breasts
and feel sick could this mean I have
acctualy feel and am exsperiencing
implantation bleeding? Many thanks.
Kurt
Barnhart, MD, MSCE responds:
PCO is a condition of irregular cycles and elevated hormones (androgens). It
is associated with increased weight and pco-like ovaries on ultrasound. Losing
weight would help your cycles and your chance of getting pregnant. Some
clinics do have restrictions regarding weight. Ours does not. Good
luck. |
Monique asks:
I just received word today that my second IVF cycle failed. I don't know what
to do. I have been diagnosed with PCOS with
insulin resistance. I have been on Metformin for the last year or so. As
well as prednisone to help control my hormones. I have taken Dostinex to
help control my prolactin level, but have since stop taking. My reproductive
endocrinologist believes it is under control.
My first cycle lasted about nine
days with me receiving HCG on day
9. The cycle produced 35 follicles,
but we only obtained 12 eggs - a
lot of them were not mature, we transferred
three great looking embryos. My second
cycle lasted about 12 days with me
receiving HCG on day 12. This cycle
produced five follicles via ultrasound,
but when we got to retrieval we thought
we had obtained nine eggs, but only
eight were obtained. Out of the eight
only five were mature, and two fertilized.
They both appeared to be of good
quality one had a few fragments.
I have a strong concern with the
quality of my eggs because of the
PCOS. Please advise what I would
do next. I live in Philadelphia.
My insurance will only pay for two
more cycles, so I don't want to waste
this opportunity.
Clarisa
Gracia, MD responds:
It is very difficult to counsel you since I do not have all of your records.
However, IVF success is highly dependent on the program - and usually reflects
the quality and experience of the embryology lab. You can view program success
rates for women in your age group using the published CDC information - you can
find a link to this information on our website on the success
rates page.
If you would like to meet for a
consultation - please bring your
records and schedule a visit at one
of our offices. We would be happy
to meet with you! Feel free to contact
us at 1-800-789-PENN (7366) or request
an appointment online. |
Alyssa asks:
I was diagnosed with polycystic
ovaries (PCOS) two years ago. Over the past two years I grew cysts on my
fallopian tubes, and I just recently had surgery because one torsed my fallopian
tube. I now have over sized ovaries, and 1 fallopian tube left. I have been on
birth control for 6 months now and I have only had my period for about 12 hours
each month. Does all of this mean I won't be able to conceive normally? Thanks
a lot.
Samantha
Butts, MD MSCE responds:
Having PCOS and having lost one fallopian tube are challenges to getting pregnant.
However, its impossible to know what the true impact of these things is on your
fertility until you start to attempt getting pregnant. I would discuss these
concerns with your gynecologist now and once you begin trying to get pregnant
you may want to seek the consultation of a specialist in infertility. |
Dianne asks:
I had a tubal pregnancy and a regular pregnancy last year, which I lost both
of them. The doctor had to remove my left tube because it burst. He said
that the right tube was blocked. I had an HSG done and it confirmed the blockage.
Would it be better to have it removed to avoid any risk of getting pregnant?
I
have a hard time getting pregnant anyway
because I have PCOS and hypothyroidism.
However, I have gotten pregnant now
3 times. Miscarriage in 2002, normal
delivery in 2004, and tubal and regular
miscarriage in 2005. What would be
the best thing for me to do? Would
it be best to have the other tube removed
since it is blocked?
Samantha
Butts, MD MSCE responds:
The first thing I would recommend (if you haven't done this already) is
to have discussion with your doctor about what your options are for getting pregnant
in the future. Your history is complex and there are several options for
dealing with your blocked tube and treating you so that you can conceive.
For
instance, one possible option is to
do a procedure in which the tube is
opened and repaired which would give
you a chance of conceiving naturally. This
procedure has risks however, and not everyone is a candidate. A second
option would be using in vitro fertilization, which would require the involvement
of an infertility specialist.
Start by talking with your doctor
but if he or she is not an infertility
specialist I think you should be seen
by one.
Good luck! |
JM asks:
I am a 36-year-old mother of one beautiful daughter who is now eight. I
had been diagnosed with PCOS shortly after having her. After many attempts
at weight loss with Metformin, I underwent gastric bypass and successfully lost
130 lbs. PCOS still remained, but I managed to get pregnant again after
five years of trying. I lost the baby at 13 weeks.
After a few months, I started Clomid,
but only gave it 5 months as I was
too depressed so I took a break. Soon
after my husband was diagnosed with
Gliobalstoma Multiforme IV. I
want so desperately to have another
child before it's too late. I
want my daughter to have a sibling
with the same parents. My
husband was not interested in freezing
sperm at the time of the devastating
news and now is on a clinical trial
using Avastin. He also underwent
6 weeks of radiation and 9 months
of chemo (Temador).
My question is
can his sperm be "washed" to
separate undesired sperm that may
cause birth defects? Is there any
possibility he can even have fertile
sperm?
Kurt
Barnhart, MD, MSCE responds:
I am sorry to hear about your complicated situation. You should seek advice
from a full service fertility clinic that can help you and your husband. The
main issues is that the treatment your husband received may decreased the sperm
count and the ability of the sperm to fertilize your egg. The issue is not really
that it will result in a child with birth defect, but that it may be difficult
to get pregnant.
Please get a full evaluation regarding
your PCOS and have your husband get
a semen analysis. It is possible
that you can have a healthy child
with some assistance. Best of luck
to you. |
Katherine asks:
I am 31 years old. I stopped taking the pill in April and had a period in May.
I haven't had regular periods since then. My gynecologist detected a cyst
in April, so I had an ultrasound in May. Results were normal with a very
small cyst on the opposite side she originally suspected. I took Prometrium
and got my period in July. Tests were done on my thyroid, glucose, prolactin,
etc. which all came back normal. I am not obese, don't have a problem with
acne, and am not growing hair in strange places.
My gynecologist wanted me to try
Clomid, but I was reluctant until
I knew more. I switched doctors.
My new gynecologist said he did not
suspect PCOS as a result of my previous
tests, but he did order an FH and
LSH. FH was 3, and LSH was 12. He
suspects PCOS. Is this accurate?
Also, what does an LSH of 12 mean,
and will Clomid be effective with
this? I have an appointment with
Dr. Gracia in November, but I have
a lot of anxiety about this, so any
information would be very helpful.
Thanks!
Response
An LH/FHS ratio greater than 3 may be suggestive of PCOS. I would also suggest
having a fasting insulin level done. Clomid would probably be very effective,
as well. |
Tacha asks:
Hi, I'm 28 and I have been trying to conceive for one and a half years. I had
one failed pregnancy (ectopic) and still am not able to conceive. I have
polycystic ovarian syndrome (PCOS), and after the ectopic pregnancy, my menstrual
cycle went irregular again, even with my medications (metaformin). Do you
think I will conceive and have a normal pregnancy, even with Type 2 diabetes?
Kurt
Barnhart, MD, MSCE responds:
Yes, I do believe it is possible for you to conceive and start a family, despite
your difficult past and your diagnosis of diabetes. I would suggest you see a
reproductive endocrinologist like the ones at Penn Fertility Care to evaluate
your entire situation, including your tubes, your cycle and your diabetes. I
am confident that we can help you. |
Waiting for
our First asks:
What kind of success rate is generally seen with IVF for PCOS patients? I am
a 25 year old woman with PCOS, am not overweight, and have had a clear HSG. I
am anovulatory and have not responded well to clomid and have had one cancelled
injectables cycle so far (due to overstimming). My husband's SA came back normal.
My husband and I are wondering what kinds of success rates are generally seen
in a case such as ours?
Pasquale
Patrizio, MD responds:
At your age and with a diagnosis of PCO, your chances of success are very high
with IVF - greater than 50 percent. |
Aurban asks:
I recently was diagnosed with PCOS. My husband and I have been trying to get
pregnant and my Ob/Gyn has put me on Metformin. I am hearing that so many
people are on Clomid to try to get pregnant. Is this the right drug for me?
Kurt
Barnhart, MD, MSCE responds:
Recent evidence-based information has demonstrated that the best treatment for
someone with PCOS who is trying to get pregnant is Clomid, not metformin. Additionally,
one should never make assumptions that there is not a secondary cause contributing
to your difficulty. You should get a complete work up by a subspecialist like
those at Penn Fertility Care. Good luck, and I hope you are able to start your
family soon. |
Kristy asks:
My husband and I have been trying with no luck for eight months. Recently we
thought I had PCOS but blood tests came back normal. Is there something
else I should be tested for, that has all the similar symptoms of PCOS
that would help us know the best route for us to conceive?
Samantha
Butts, MD responds:
The first thing I would recommend is having your case reviewed by an infertility
specialist. While PCOS is a common condition that causes irregular periods and
irregular ovulation there are other hormonal conditions that can mimic it and
should be ruled out if appropriate. Based on the complete evaluation of both
you and your husband an appropriate treatment protocol may be devised to help
you conceive.
|
Deanna asks:
I am 33 and have never menstruated on my own since I was 12.
I have been diagnosed with PCOS (polycycstic ovary syndrome). I have an extremely
high testosterone level. I have been put on Clomid and
underwent a couple of months of injections, to no avail. I have been
trying to get pregnant for five years. Financially, I cannot afford the
injections. What other options would you suggest that are not too
costly?
Kurt
Barnhart, MD responds:
I am sorry to here about your difficulty. PCO is sometimes difficult to
treat. Clomid is the best first step. Sometimes it can be combined with
other medications like an insulin sensitizer. Sometimes the injectable medications
or even in vitro fertilization are your best options despite the initial high
cost.
You may benefit from a re-evaluation
of your entire case and a new opinion
regarding your treatment options.
We would be happy to help. If you
would like to consult with a Penn
fertility specialist, please call
1-800-789-PENN (7366) or schedule
an appointment online. |
Jo asks:
I am twenty-seven, and I have PCOS (Polycystic Ovarian Syndrome). My husband
and I have been trying to conceive since December, 2003. I have had two intrauterine
inseminations (IUI's) with Clomid (I do not know why these were done when
I did not ovulate on Clomid). I have tried Clomid and Met, as well as one
cycle of Gonal-F, and now I am on my first cycle of Menopur (I just went
to 225 iu's/day). My reproductive endocrinologist wants to stop after this
and send me for in vitro fertilization (IVF), as I have not responded at
all to the medications.
What would you recommend to a patient
in this situation? Continue with
Menopur and move up, or go to IVF?
Or would you recommend ovarian Drilling
(which I am terrified of)?
Steven
Sondheimer, MD responds:
If you have not ovulated on any of these medications, then the first goal is
to help you to ovulate. Each reproductive endocrinologist has their own recipe
or plan in this type of situation. If you are overweight, you should work hard
to follow a weight-loss diet, similar to that recommended for an overweight adult-onset
diabetic person, and include a daily walk of 30 minutes.
I usually monitor follicle growth
by ultrasound and blood estrogen
levels, increasing the dose of clomiphene
citrate (even up to five pills a
day), and then use human chorionic
gonadotropin (HCG) to induce egg
release if one or two of the follicles
achieve adequate size. Good luck. |
Alyssa asks:
I am a 25-year-old woman who was diagnosed with polycystic ovarian syndrome (PCOS.)
I was taking clomid for three months, with my reproductive endocrinologist
(RE) increasing my dosage each month. I conceived in the third month, taking
3-50 mg tablets a day, but miscarried at six weeks. My doctors are frustrating
me with unanswered questions.
They terminated the pregnancy by giving
me a shot without doing an ultrasound,
speculating an ectopic pregnancy because
of my slow-growing human chorionic
gonadotrophin (HCG) levels. No other
testing was done. What would you recommend
my next course of action be to get
pregnant again? I also ovulated each
month on clomid, but my progesterone
was extremely low. Is there anything
thing that I can take along with the
fertility medicatons to increase progesterone?
Samantha
Butts, MD, MSCE responds:
If you have not done so already, I would recommend have an extensive conversation
with your physician about the recent pregnancy and plans for moving forward.
If it is believed that you had an ectopic pregnancy, your fallopian tubes may
be damaged, and doing additional cycles of clomid/intrauterine insemination (IUI)
may not be appropriate until that is formally evaluated. If you are not getting
satisfactory answers from your physician, you may want to seek out a second opinion. |
Woman in Waiting
asks:
I'm in my 2nd injectables cycle 13 dpiui right now. Diagnosis is PCOS, I'm 25
y/o. This was my first ovulatory cycle since ttc in sept 02. (1st cycle was cancelled).
I got a + hpt at 12dpiui and temps went triphasic at 11-12dpiui. I had a beta
done yesterday (12dpiui) and it was only 33, which I was told was + and indicative
of early pregnancy.
From everything I've read, the beta
should be 50 by 12dpiui. I know all
I can do is wait for a 2nd beta but
the office wouldn't schedule me to
come in until 16dpiui because 14
days falls on a weekend. I know it
is possible that this could go on
to be a viable pregnancy, but in
most instances, would an embryo with
a beta this low result in m/c?
Richard
Tureck, MD responds:
What is most important is the repeat HCG - it should approximately double in
48 hours. I wish you luck. |
Katy asks:
I stopped taking the pill in April of
this year. I had a period in May
but none since. I have been given
Prometrium, but my body does not
get a period on its own. My gynecologist
ordered tests and suggested I see
a fertility specialist. I went to
a new gynecologist who could find
no reasons for the missed periods
based on the tests the other doctor
had ordered.
He ordered two more tests: LH and
FSH. The results of these indicate
PCOS. Since my other tests didn't
seem to suggest PCOS, is it possible
that I have a mild form of PCOS?
I made an appointment with Dr. Gracia
for next month to start Clomid. What
are the success rates of patients
with PCOS and Clomid? I'm 31 years
old.
Response:
You may be right. You may have a mild
form of PCOS.
The problem sometimes is also with
the testing of the male hormones.
The laboratory assays are not calibrated
well for women's low levels and thus
the results come back as normal.
Usually, between the patient's history,
lab results and ultrasound of the
ovaries a diagnosis can be made.
Clomid, although not always successful,
is an excellent first line drug to
which most of the patients respond.
The important thing to know is that
there are many approaches that usually
end up with success. I am sure Dr.
Gracia has already reviewed all this
with you. For more information, please
take a look at this encyclopedia
article. |
Mary asks:
What birth control method do you recommend for someone with PCOS after childbirth?
Anuja
Dokras, MD, PhD responds:
Birth control pills are my first
preference as they have several advantages.
They make menses regular, less painful
and lighter, decrease the risk of
cancer of the uterus, decrease acne
and decrease hair growth.
If you would like to schedule an
appointment with a Penn Fertility
Care specialist, please call 800-789-PENN
(7366). You can also request
an appointment online. |
MM asks:
I was diagnosed with polycystic ovarian syndrome (PCOS) at the age of 24. I have
all of the symptoms (acne, excessive hair on face, overweight, etc.). I have
had two miscarriages in a time span of one and a half years, with the use
of Clomid during a four-year time period. I recently lost 35 pounds and ovulated
on my own for the first time. This month I did not ovulate so my doctor suggests
that I go onto fertility shots (FSH/LH).
My question is, is it possible that
a person who has been able to get
pregnant (but have those pregnancies
fail) be able to get pregnant with
these fertility shots, and have a
successful one at that? Thank you.
Kurt
Barnhart, MD responds:
I am sorry to hear about the difficulties that you are having in conceiving.
I am sure it is frustrating for you. However, congratulations on taking control
and losing the weight. That will help all aspects of your care.
It is certainly possible for you to get pregnant, and keep it, with the shots
that you mentioned. The decision to use them is a complicated one, however. The
idea is that they will help you get pregnant "sooner."
However, the drawbacks are that you will need more visits, and have higher
risks of multiple birth.
I would recommend a consultation with a fertility specialist about all of your
options. That way you can make an informed choice.
If you would like to schedule an
appointment with a Penn Fertility
Care specialist, please contact 1-800-789-PENN
(7366) or request
an appointment online. |
Mrs. Dennis266
asks:
I have been diagnosed with PCOS. I have been trying to get
pregnant for 2 1/2 yrs. I have been taking clomid for 3 cycles and I am not pregnant
yet. Can you tell me what progesterone support is and if it is hCG? Also can
you tell me when I am supposed to take hCG or progesterone support and how much
I should take?
Christos
Coutifaris, MD, PhD responds:
The question is whether you are ovulating on clomid or not and at what dose.
Frequently, the luteal phase (the two weeks after ovulation) needs to be evaluated
to decide whether progesterone is needed or not. Usually, if follicular development
is good with good size follicles, there is no need for progesterone.
No,
hCG
is
not
progesterone.
hCG
can
be
used
to
help
with
the
actual
expulsion
of
the
egg
from
a mature
follicle
if
your
own
body
does
not
trigger
this
process
with
a hormone
called
LH.
Your
fertility
physician
should
be
the
one
to
decide
whether
you
need
hCG
and/or
progesterone
based
on
the
monitoring
of
your
cycle.
You
should
address
these
questions
to
your
physician.
If
you
are
not
seeing
an
endocrinologist
and
infertility
specialist,
it
would
be
a good
idea
to
make
an
appointment
with
one.
We,
at
Penn
Fertility
Care
specialize
in
treating
patients
with
PCOS
and
we
would
be
happy
to
see
you. |
ShamoneE asks:
I am a 25 year-old woman who suffers from Polycystic Ovarian Syndrome (PCOS),
and I haven't had a period on my own in about three years. Myself and my
husband have gone through two failed in vitro fertilization (IVF) cycles,
and after both we did not have any embryos left.
After a consultation with
my reproductive endocrinologist (RE),
she advised that she suspects poor
egg quality. I find it very disturbing
that I am only 25 and I may have to
use donor eggs. Is there any hope for
me to achieve a healthy pregnancy using
my own eggs.
Clarisa
Gracia, MD, MSCE responds:
It is very unusual to have to go through donor egg at age 25, unless you have
premature ovarian failure. Usually PCOS is associated with a brisk response to
injectable medications. I would suggest going for a second opinion.
|
Dorianh11 asks:
In February 2007, I was diagnosed with human papillomavirus (HPV) and Polycystic
Ovarian Syndrome (PCOS) after having a leep surgery performed. A month later,
I had a cold knife surgery performed.
It has been a month since the cone
procedure, and two months since the
leep procedure. I am bleeding very
heavy with blood clots. My question
is: Am I supposed to bleed this heavy,
and if so, for how long? And will I
ever be able to get pregnant, being
that I have never been pregnant before.
Clarisa
Gracia, MD, MSCE responds:
It is very difficult to answer these questions not knowing your entire history.
However, the cold knife cone usually does not prevent pregnancy. If you do have
PCOS, you may not be releasing an egg every month. This may be the cause of your
infertility, and also your irregular heavy bleeding. I suggest you see a gynecologist
to help sort these issues out.
|
June asks:
At what point should a 35-year-old anovulatory woman with PCOS seek treatment
for infertility? I don't believe that waiting the standard 6 months to try
to conceive on my own is appropriate since I don't know when I ovulate. But
there are no other guidelines out there for a woman like me!
Steven
Sondheimer, MD responds:
Ask your doctor to check if you are releasing an egg (ovulation). Keep an accurate
bleeding calendar and begin keeping a basal body temperature chart. Check your
temperature each morning before get out of bed. Bring that information to your
doctor. Your doctor should want to do a progesterone level check about one week
before your period starts to confirm ovulation.
If you are not ovulating then
your doctor may want to begin giving
you medication to help. Usually clomiphene
citrate is used but he/she will take
into consideration if you would benefit
from the use of metformin (glucophage).
As you have said, if you are not
releasing an egg at all then beginning
evaluation and treatment before 6
months is the right thing to do.
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Gina asks:
After being diagnosed with endometriosis, about 10 years ago, I was treated with
everything available prior to seeing a fertility specialist. My husband and
I then saw a fertility specialist and for a year we went through the interuterine
injections with all the hormonal stimulation too! Now I am hearing that the
pituitary gland and PCOS can be a cause of inability to concieve as well.
Also,
about five years ago, I became pregnant,
but for an unknown reason, the fetus
stopped developing at about 20 weeks.
Since then nothing. I am curious about
the testing of the pituitary gland
and for PCOS. What types of test should
I ask for and what kind of results
do either of these diagnosis produce?
Steven
Sondheimer, MD responds:
Gina, endometriosis is one of the most common causes of infertility. How endometriosis
interferes with conception is not totally understood. In some cases scarring
from the condition makes it difficult for the sperm to find the egg. Polycystic
ovarian syndrome (PCO) is another cause of infertility. It interferes with fertility
by preventing ovulation. Neither of these problems can explain your tragic loss
of the pregnancy at 20 weeks.
To determine if a women has an ovulation
problem such as PCO or a pituitary
problem, a thorough history needs to
completed especially concerning the
regularity of your menses, the presence
of symptoms such as increased facial
hair, hair loss, acne, breast discharge
or problems with obesity or weight
loss. The doctor can order hormonal
tests to confirm ovulation, evaluate
androgen levels and pituitary hormone
levels. These tests often need to be
done at specific times in the menstrual
cycle. A fertility specialist should
be very familiar with this type of
evaluation. |
Michelle asks:
I am currently doing my first IVF cycle. I started taking my Follistim 300 units
a day four days ago. I was told that my estradiol level was 734 and had many
small follicles (I have PCOS). I was told to reduce my medication to 225
units a day.
With small follicles and a high
estradiol level with only four days
of follistim, will I eventually stimulate
with this medicine? I did stimulate
with 250 mg of clomid six out of
eight times.
Steven
Sondheimer, MD responds:
You have stimulated. That is, you have many follicles which have started to grow
and which eventually could yield an oocyte (egg). The problem is that you are
at high-risk of over stimulating, which can result in a number of potential problems
some of which are potentially serious.
The risk of multiples in a pregnancy
is not as great with in vitro fertilization
(IVF) as intrauterine insemination
because you can limit the number
of embryos transferred. There is
still a risk of the hyperstimulation
syndrome which could require intense
treatment and has a risk of serious
consequences. Your doctor might decide
to cancel this cycle in order to
limit your risk and try a different
stimulation protocol to see if the
response can be reduced.
There are also other approaches
to decrease your risks such as lowering
the dose of gonadotropin which you
are using. You should discus your
concerns with your physician. I believe
a fully informed patient is best
able to participate in their care. |
MMatash asks:
I am 28 years old and am trying IVF for the first time. I was diagnosed with
PCOS and suffered two miscarriages. My FSH results on day three were 4.9,
which I was told was good, according to my lab. Since I have PCOS, will I,
with this FSH level, have some good eggs left to be able to conceive? I'm
just worried because both miscarriages did not show any embryo tissue.
Steven
Sondheimer, MD responds:
In general at your age and with your history you will possibly respond vigorously
to the gonadotropin stimulation and could have many oocytes retrieved. One of
the concerns will be that you might stimulate so much that you could be at an
increased risk of the hyperstimulation syndrome.
Have you discussed with your
doctors other alternatives? Metformin,
a medication used to treat insulin
resistance, often helps ovulation
in young women with PCO. I know it
is easy to get impatient but maybe
there are alternatives to explore
before starting an IVF cycle. At
least consider discussing this with
your doctor. |
Micky asks:
I am 37, pushing 38 real soon and anxious. We have been trying to become pregnant
for over ten years. We have a wonderful 14 year-old already, conceived naturally,
but I have PCOS and have been unable to get pregnant. I have been going to
a fertillity specialist since 1997 with no luck. I had the HGC shots, Prometrium,
Metformin, and so many others I can't remember. Am I not doing something
right? This is my last year I will be trying...please help!
Richard
Tureck, MD responds:
I would like to help you but unfortunately I cannot give you appropriate advice
without knowing all the specifics of your infertility treatment. We would be
happy to see you for a second opinion if you wish. If you would like to schedule
a consultation, please call 1-800-789-PENN (7366) or schedule
an appointment online. |
Shane/Rudy
asks:
I have been undergoing infertility treatments for over a year now, successful
once on a Clomid cycle which ended in a chromosomal-related miscarriage. Since
then we've done five unsuccessful IUI's on Clomid and one round of injectables.
My husband's count is on the lower side of normal and I have PCOS but am oligo-ovulatory.
We have decided to do IVF.
Why should I have more hope in IVF
than any other treatment we've been
trying? I have been a great responder
on all medications and have had a
normal HSG.
Kurt
Barnhart, MD, MSCE responds:
I am sorry to hear that you have not conceived as easily as your earlier treatments.
IVF is the best and most aggressive treatment we have to assist couples. Because
we get many eggs with IVF and choose the "best"
embryos to transfer back to your uterus
we are able to maximize your chance of
getting pregnant.
In other words it is
not that you have to have IVF to
conceive, but IVF offers you the
best (and fastest) way of achieving
your goal. Of importance in IVF is
the quality of the laboratory of
the program. You should carefully
evaluate the program's success rate
and in your case the pregnancy rate
using cryopreserved embryos. You
are likely to have more embryos that
you will transfer back, and those
should be cryopreserved for future
attempts.
The success rate at Penn Fertility
Care is far higher than the national
average. We would be happy to take
care of you. If you would like to
schedule a consultation, please call
1-800-789-PENN (7366) or schedule
an appointment online. |
Carrie asks:
I have been trying to conceive for 1-1/2 yrs. My ob/gyn diagnosed me with ploycystic
ovarian syndrome (PCOS) as my cause of infertility. Hormone ratio was 2-1/2:3.
I also have the classic symptoms of PCOS (obesity, acne, excessive hair).
HSG showed both tubes open. No male factor problem. I completed my first
month on Clomid, which did not make me ovulate. Progesterone level was only
0.8; my doctor said it should be above 10. He recommends using the Clomid,
until 200mg.
If still unsuccessful, he will refer
me to a reproductive endocrinologist.
I've decided I'd like to see Dr.
Samantha Pfeifer. Should I wait three
more unsuccessful months before seeing
her? I feel like this treatment method
is only treating my infertility,
and not PCOS — which I'd really
like under control. Please advise.
Richard
Tureck, MD responds:
Unfortunately, without the results of your blood tests, I cannot comment appropriately.
However, I suspect you had a fasting glucose and insulin drawn, as well as testosterone,
prolactin, and 17 OH progesterone. It is recommended that you see a fertility
specialist after trying to conceive for at least a year if you are under age
35 or after trying to conceive for at least six months if age 35 or older.
Samantha Pfeifer, MD is excellent
in the specialty of PCOS and in infertility.
If you would like to schedule a consultation,
please call 1-800-789-PENN (7366) or request
an appointment online. |
Ian asks:
I am a 37-year-old woman that was diagnosed
with polycystic ovarian syndrome
(PCOS) about nine years ago. I
already have had two children.
My youngest is 10 and I have been
having unprotected sex with the
hopes of conceiving again, for
about two years now. I was told
by my doctors that I am no longer
ovulating and I do not have regular
cycles. What would be the best
fertility option for me with having
PCOS and what are the success rates
for someone in my condition.
Richard
Tureck, MD responds:
The first thing to do is obtain
hormonal blood tests. Based on
these blood tests, the proper medications
can be prescribed. I advise that
you see a fertility specialists
if you are not currently seeing
one. A fertility specialist will
review your medical history and
will prescribe a targeted course
of action for your specific fertility-related
condition.
|
Lynn asks:
I have had 3 consecutive miscarriages this past year. My husband has been under
a lot of stress. Can a husbands stress cause miscarriages? P.S. I had a healthy
pregnancy before these 3.
Moderator responds:
Your husband's stress cannot cause a miscarriage but it may add to your stress,
which could adversely affect your health. Penn Fertility Care advises women
to seek a fertility specialist if they have lost two or more pregnancies due
to miscarriage, have been trying to conceive for over a year (under age 35),
have been trying to conceive for over six months (age 35 and over) or if you
have any other underlying gynecologic issues (ie. endometriosis or PCOS). We
wish you luck. Feel free to contact us if you decide to be evaluated by a fertility
specialist.
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