QuestionQUESTION: Hi dr. Im 24 i hav never been pregnant before,I have polycystic ovarian syndrome i have had a regular period for the past 3months and im healthy slightly overweight and have an arcuate uterus. My husband and I are scheduled to go for IUI next week after trying for years. My question to you is can I request a removal of my cysts in the particular egg that will be inseminated or is this part of the procedure to increase the chances of falling pregnant and what does the process entail? Would irregular menstruation cause any delays?
ANSWER: Hello Nicolene from Norway,
I am not sure what you are referring to when you say "removal of my cysts in the particular egg that will be inseminated". If you are referring to your condition of PCOS, then these are not classic "cysts", but rather follicles within the ovary. These are normal follicles, but there is an increased number seen on ultrasound in patients with PCOS. These follicles really have nothing to do with the condition, PCOS. In fact, the name PCOS is a misnomer given before we understood exactly what the problem was. The problem in PCOS is that the ovary does not function correctly so that ovulation does not occur. Cycles usually are irregular. Because of this it becomes difficult to achieve pregnancy. So, in PCOS, the "cysts" seen on ultrasound are of no consequence, and no treatment is required to remove these cysts.
In actuality, these "cysts" are follicles within the ovary and the follicles contain the eggs that are ovulated. As the ovary is stimulated by the brain or with fertility medications, one or more of these follicles will grow and the egg within will go through a maturation cycle. Once mature, the follicle will rupture (ovulation) and the egg will be expelled into the culdesac of the pelvis to find the fallopian tube. With IUI, the sperm is injected at the approximate time of ovulation so that the sperm will be in the tube at the time the egg is picked up (if the egg is picked up. This is a random event and does not necessarily occur each cycle.).
I hope this answers your question.
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, and follow me on Facebook at http://bit.ly/9Iw9oV
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QUESTION: Hi dr. B4 going 4 IUI i decided to try clomid as suggested by my dr and i was told to return on the 10th day to check on my ovaries the ultrasound report reads: anteverted uterus, =4.8 x 2.4cm with smooth texture , endometrium =0.6cm no cx lesion noted Right ovary=4.2x2w6cm with strall follicles around the periphery, no dominant follicle Left ovary=3.9x2.2cm same picture as right ovary features implying PCOS.
Could u please explain what this means. Im not menstruating at all for several months now. I was told not to take any other meds but I did take sinutabs, could this have an effect on my ovaries since i was told both my ovaries have to be 10cm. Is this a sign that the clomid is not working?
Thanks in advance
AnswerHello Again,
This is definitely a question that should be answered by your doctor! That is what you pay him/her for.
The ultrasound shows characteristics of PCO, as you know, and does not show any signs that the Clomid dose you are using is sufficient because there are no developing pre-ovulatory follicles. The sinutabs would not affect anything. You should have another ultrasound around cycle day #16 to see if the development is just slow, which happens sometimes with PCO patients. If there is still no sign of any response, then I give my patients Provera for 10 days to induce a period and restart the cycle with the next period. This time the Clomid dose should be increased. In general, I use 200-250 mg per day in my PCO patients because they tend to be resistant to Clomid. If you don't respond to that dose of Clomid, then you would need to try Femara 7.5 mg per day or move to the injectables like Follistim or Gonal-F.
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 and facebook @montereybayivf
