QuestionHello Dr. Ramirez!
My cousin was recently diagnosed with PCOS, and after
hearing about her symptoms I suspect I have it too.
I am 25 years old and I have had two first trimester
miscarriages (at age 22 and 24) with both pregnancies
conceived when I forgot to take my birth control pills.
After the second miscarriage, I went off the pill to try to
conceive again. It has been eight months off the pill now,
and I have been home testing for ovulation twice a day,
every day, but have not had an LH surge. I have also gotten
back my acne and facial hair, both of which were not
problems for me while I was on the pill. Also, despite not
making any diet changes and continuing to exercise for an
hour a day three times a week, I have stopped losing weight
and started to gain again. Losing weight was much easier
when I was on the pill even though my hypothyroidism has
remained controlled on the same 50 mcg dose of Synthroid for
the whole time.
My gynecologist says PCOS is not a concern for two reasons:
I have repeatedly tested normal for fasting blood sugar, and
the vaginal ultrasound I had during my second miscarriage
did not show any ovarian cysts. Rather, he says that all my
problems are due to my obesity (my BMI is 50). I know that
my weight is a major problem and I am trying to work on it,
but I wonder if I might also have PCOS. I am interested in
what you think about my self-diagnosis efforts, and also
wondering if I should switch doctors. Are fertility
specialists willing to see patients with extreme obesity?
Thank you for your time and answer!
AnswerHello Rachel from the U.S.,
PCOS is a clinical diagnosis and there is not only one criteria to make the diagnosis. Basically if you have any two of the features of PCO, then the diagnosis is made (assuming you don't have any other reason for the ovarian dysfunction#. So, for instance, if you are not ovulating, and therefore do not have regular menstrual cycles, that is one criteria that you meet, and if you have increased facial hair #hirsuitism), that is another. Also, increasing weight gain is another. Sure if you have diabetes, or insulin resistance, or PCO appearing ovaries, or elevated testosterone levels, or and inverted LH/FSH ratio then you also meet the criteria for PCO, but you don't need all of them.
Your doctor is correct that exogenous obesity, also called morbid obesity, is a factor in your hormonal situation. It is also a cause of PCO, so they do go hand in hand, not one or the other. The excess fat causes hormonal problems because there is excess hormone production from the excess fat cells. Cholesterol, made from fat cells, is the basis for all hormones. Having excess hormones can be like taking the birth control pill. The brain sees the excess hormone and turns off the mechanism to make hormones.
So, losing weight may be the answer to both your obesity and your PCO, which would allow you to become pregnant. Seeing an RE might be better than your regular gynecologist, but whether they will treat you at your weight is a question I cannot answer. It is probably dependent on an individual's philosophy.
Good Luck,
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
