QuestionQUESTION: Iam 32 yrs old. and have pcos and thyroid. I did 6 cycles of clomid with my gynecologist. Out of which only 2 cycles i had progestrone level of 10 on 21 day of the cycle.
I went to an RE, he did all the initial blood work and HSG.
I have both of my tubes open and everything looks good.
My thyroid is normal.
I have abnormal
Anti Microsomal Antibody(TPO) Method-CLIA: 396.5
Less than-40.0 IU/ml-Negative
More than-40.0 IU/ml-Positive
He put me on clomid 150 mg for 6 days from cycle day 6-11, as my progestrone lvels were good on earlier two cycles.
He monitered with ultrasound and blood test for LH and Estradil.
There are no prominent follicles.
He ordered the following blood tests on same day
progestrone-lessthan 0.20
Lh-9.3
Estradil-42
We did another three rounds of bloodwork alternate days to check my LH and Estradil.
Cycle day 20.
Estradil-40
LH-12.3
Cycle day 23
Estradil-44
LH-11.2
Now he suggests three options
1.Another round of Clomid(as its less expensive)
2.Injectable medications
3.IVF.
I want to go for injectables as I have already tried 6 cycles of clomid.Iam having a feeling that Iam clomid resistant.
Is it a good option to go for laproscopy before doing injectables cycle?
Though my HSG shows no abnormality.
What do you suggest. I have been trying from past 3 years and very frusttated with all this.
Please Kindly advice.
ANSWER: Hello Amulya,
If you want to continue with a "natural" treatment track, like IUI or intercourse, then you may want to consider doing a laparoscopy to get rid of any residual endometriosis. Any endometriosis present in the pelvis will prevent natural pregnancy from occurring. If you are planning to move to IVF, then the laparoscopy is not required because IVF bypasses the pelvis and so it does not matter if endometriosis is present.
As of now, you have not been adequately treated with Clomid. It can be used up to 250 mg per day (5 tablets) and only 5 days is necessary. Another alternative is a drug called Femara, that can be used up to 7.5 mg per day (3 tablets), also for 5 days. If you do not respond with these, then you would move to the injectables using either Follistim or Gonal-f (FSH only) starting at very low doses. The problem with PCO ovaries is that they are very sensitive to the injectables and tend to produce too many follicles. This is a difficult problem and needs to be carefully monitored by a doctor that knows what they are doing. I'm not sure why your doctor did all the blood tests with the Clomid cycle. That was unnecessary. I would recommend that you look up my blog where I have written extensively regarding PCO and ovulation induction.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
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QUESTION: I had a laproscopy on may 30, 2012. They diagnised moderate endometriosis.
I haven't got my period then. Iam 32 yrs old PCOD & hypothyorid,
My doctor did some blood work and told me that, I can start injectables after the U/S scan.
As I have irregular periods. No need to wait for the period as my estardil & progestrone levels were low.
Will it have any effect on IUI succes rate, if we start injectables without period?
Please advice.
AnswerHello Again,
I don't suggest it. Your doctor has no way to know what stage your ovaries are in. It would be hit or miss at this point. I would recommend that he induce a period, by either using Provera or Birth control pills, then start the cycle from that point.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
