Dear Dr. Lee,
I was wondering if I could run my situation by u and get some advice or possibilities on what my prob. could be. I have been happily married for over 10 years now. I got preg about 10 years ago when we were first married and miscarried. I have not been preg. since. My periods were always irregular sometimes absent for months sometimes lasting for 3-4 weeks. I had an ultrasound and was diagnosed with PCOS - I have been on metformin for 5 months now and did 2 months of clomid and 3 months of letrozole with nothing. Now I am waiting for my husbands insurance to kick in to have laparoscopic surgery. My husband has been tested and he is fine so the prob lies somewhere within me - what could this be and do u think I could ever even become pregnant. I am 26. Yes, I got married young. I am desperate because my mother and all three of her sisters ended up having to have hysterectomies before they were in their thirties. Any advice would be appreciated. Thankyou.
"B", from Arkansas
Can you provide some additional information?
Did you grow any follicles on the Clomid or Letrozole?
Did you ever try injectable fertility medications?
What is your approximate height and weight?
Did you have an HSG already to see if your tubes are open?
Dear Dr. Lee,
Just within the past two years we have decided to look into this and after a consultation and an ultrasound, I was diagnosed with PCOS. We also had my husband's sperm tested which came back fine. The doctor put on metformin and clomid. I did both for two months with no results. I then continued the metformin and did three months of letrozole. This too ended with no results. We are now at a holding point waiting for my husbands medical insurance to go into affect to take the next step in having laparoscopic surgery to find out more. Being that this was all paid out of pocket and we had no insurance, ( I would imagine this is the reasoning ), I was never told about any follicles growing while on clomid or letrozole. I did recently give a blood test to see if I was even ovulating but have yet to hear the results. I have not tried the injectable fertility treatment because after discussing it with my doctor, decided to start with a less expensive approach again until the insurance takes affect. I am not sure what a HSG is to see if my tubes are open and suppose if I had had one I would know so I guess I have not had that done. My mother and all three of her sisters all had to have hysterectomys in before or in their early thirties so at 26 I am getting more anxious. I am racking my brain trying to figure out what could possibly be keeping me from becoming pregnant especially since I was able to get pregnant 10 years ago.I am 5'4" and weigh 190 although before starting the metformin I weighed 211. As far as symptoms other than infertility, I have literally every symptom of PCOS in addition to migraine headaches, inability to sleep and when I do I have to have atleast 12 hours and even then it is difficult to wake up, and mood swings where I just get so depressed I cry (even tho I am normally a very happy fun person). A cat scan ran during one of my migraine trips to the hospital came back normal. The metformin seems to be working as I have been having normal, regular periods and little pain. Any information on what I need to do and what this could be would be greatly appreciated. Thankyou.
P.S. I have been nausiated and vomiting some the past two days and realized
that this occurs without reason maybe twice a month and lasts 3-4 days. I did
some more research on the internet and because of the pcos and being insulin
resistant, do u think I could be diabetic? I noticed this amongst my "mood
swings" and "hunger" and others were symptoms. Sometimes I wake
up in the morning and cant make it to the cupboard fast enough for something
sweet. Anyway, just a thought - I have been trying to put all this together for
years now and I want to thankyou for all your help. I will be watching for your
answer. Thankyou again.
You have been brave to endure such a long time suffering from PCOS, especially in the context of the frustration of not knowing why you were teased with a brief glimpse of being pregnant way back then. I do congratulate on your having been happily married all this time despite the obvious great stress of infertility. As, always, please accept this feedback in the context of my not knowing more about you and not having the opportunity to examine you. I would suggest you take the following information as potential topics of discussion.
Many reasons would lead any RE to agree with you having the diagnosis of PCOS (Polycystic Ovarian Syndrome). This is a disease that is not entirely understood, even today. However, we do know that it is somehow related to faulty insulin metabolism. You likely inherited a bad gene that makes your body unable to respond to insulin normally (I wonder if there is diabetes in your family). Because of this deficiency, you end up having high levels of insulin, which can interfere with egg development. It can also cause a host of other problems, including weight gain, menstrual abnormalities, hairiness, acne and increased miscarriage risk. Your doctor wisely gave you metformin (Glucophage) to address the insulin issue. It is not surprising that you have lost 20+ pounds since starting it. Keep up the good work of taking your metformin, watching your carbohydrate intake and gradually increasing your exercise level.
I have seen patients start ovulating on their own after losing weight on metformin. I truly hope it happens for you. In the event that you do not ovulate soon, then it's time to consider ovulation medications such as Clomid, Letrozole or best of all, injectable gonadotropins. Unfortunately, when you failed to get pregnant on these medications in the past, we do not know if you grew follicles and ovulated well, but just didn't get pregnant OR if you failed to ovulate even with the medications. If it's the first case, meaning you ovulated consistently and still didn't get pregnant, then I would suggest an evaluation of your tubes. This is best done with a non-surgical x-ray procedure called an HSG. The surgery that your doctor proposes is a reasonable option, but not the best one, in my opinion. Now, if it's the second case, that back when you were on the Clomid and Letrozole, you didn't even ovulate, then the obvious best plan at this point is to work harder at getting you to ovulate.
So how do we do that? In your situation, it would be reasonable to try injectable gonadotropins with close monitoring to see that you actually are ovulating! If there are no problems with your tubes, you should get pregnant with a high percentage chance once you are ovulating. As for your nausea, obviously you know to do a pregnancy test first. The relationship between diabetes and PCOS goes something like this. A normal person is one whose body uses a little bit of insulin to successfully bring the blood sugar levels down easily. An insulin-resistant PCOS person is one whose body frantically uses a lot of insulin to successfully bring the blood sugar down. A Type II diabetic is someone who despite frantically producing a lot of insulin still can not bring the blood sugar levels down. So while it is possible that you are at risk of becoming diabetic or that you are already diabetic, most likely you are not yet. A combination of diet, exercise and metformin can hopefully delay your development of diabetes until you are 100 years old! Your vivid description of your sugar-craving is classic for PCOS patients. However, you are already on the metformin, so I would have expected improvement in that area. Perhaps a combination of a higher dose (ask your doctor), more will power and REGULAR fun exercise can get those craving under better control so that you can keep losing even more weight.
KEY POINTS TO CONSIDER:
- Ask your doctors if they can focus on helping you ovulate in a proven documented fashion first before resorting to the laparoscopic surgery. If you ovulate, but still don't get pregnant, then go ahead and evaluate your tubes and uterus, either with an HSG (preferred) or with the surgery.
- Continue your great progress regarding weight loss and getting healthier.
- Based on the limited information you have given me, I would be very optimistic about your chances of having a baby within the next few months, provided you make the right decisions regarding treatment.
- Once you get pregnant, keep on the metformin as many believe it can help combat the higher risk of miscarriage that PCOS patients have when they don't take metformin.