QuestionI'm writing from Oklahoma..i have been diagnosed with polysystic ovaries and stage 2 endometriosis. I've been getting progesterone shots and have been taking chlomid and metformin. They still cant get Me ovulating. This is the last round of chlomid to see if it works. They told me to take two chlomid pills for 5 days and two metformin pills. If this doesn't work they are going to give me fertility shots next. What do you think are my possibilities of getting pregnant??
AnswerHello Susy from Oklahoma,
PCO is a difficult problem to treat and part of the infertility problem list. We usually will attempt the easy medications such as Clomid or Femara first to see if the ovaries will respond. Clomid can be used up to a maximum dose of 250 mg per day (5 tablets) for 5 days. Femara can be used up to 7.5 mg per day (3 tablets) for 5 days. Most PCO patients do not respond to this dosage because their ovaries are highly resistant. Not all PCO patients are candidates for and respond to Metformin either. It should be given only to patients with documented hyperinsulinemia (elevated insulin levels). It is given at a dose of 1500 mg per day (3 tablets). When patients don't respond to the easy medications then we have to go to the injectable fertility drugs, called gonadotropins. We usually use either Follistim or Gonal-f. This is difficult because with these medications we get the opposite effect, that is the ovaries respond too well and there are more than 3 follicles produced (sometimes as many as 20-30. This needs to be done with a Dr. that is very knowledgeable about how to use the medication.
From the limited information you have given me, I don't think your doctor is the right one to see regarding your problem (I can tell by the dosages that you mentioned). I would strongly recommend that you go see an Infertility specialist, called a Reproductive Endocrinologist. You'll know the difference because this is a doctor that does IVF. That's all you have to ask your doctor to know. "Do you do IVF?".
I have written extensively about PCO in my blog and would suggest that you look it up for more detailed information.
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
