Question pcos?
QUESTION: hello doctor,
i m from india,28 yrs old.63 kgs 162cms....we hve been married for 3 yrs.i conceived once, a year back,which ended up in spontaneous abortion and after that no luck .
last month i was put on clomid 50mg from CD2 TO CD6..and the ultrasound report on CD7 day of my periods is as follows...
1. TRANSABDOMINAL AND TRANSVAGINAL SONOGRAPHY OF THE PELVIS DONE
2.UTERUS APPEARED ANTEVERTED
3. UTERUS MEASURED 6.7X4.4X5.2 CMS
4. ENDOMETRIAL CAVITY APPEARED PROLIFERATIVE
5. ENDOMETRIAL THICKNESS MEASURED 6.9MM
6. RIGHT OVARY MEASURED 3.9 X 2.3 X 3.4cms
7. RIGHT OVARY SHOWED MULTIPLE FOLLICLES SUGGESTIVE OF POLYCYSTIC OVARY
8. LEFT OVARY MEASURED 3.4 X 2.2 X 2.8cms
9. LEFT OVARY APPEARED NORMAL
IMPRESSION
-ANTEVERTED UTERUS WITH PROFILERATIVE ENDOMETRIUM OF 6.9mm
-RIGHT OVARY APPEARED POLYCYSTIC
\
-LEFT OVARY APPEARED NORMAL..
I hve enclosed my ultrasound image(CD 7) ALSO
..and On CD 10 ,there were 3 follicles(1.1, 1.2, 1.8 cms) in my right ovary and left showed multiple small follicles
on CD 11, the sizes of the 3 follicles in right ovary are 1.6, 1.5 .1.6 cms and left showed multiple small follicles
on CD 13,they were 1.4, 2.5, 2.3 cms and i got my HCG shot on the same day.i.e CD 13
and the ultrasound taken on CD 15 confirmed ruptured follicles..
my questions are
1. Do i have pcos??(from my ultrasound image..the ovaries show round black circles..and also the report says RT ovary appeared polycystic,only on the right ovary i had dominant follicles)))
2. if so,is it severe??
3.do i hve to take metformin?
4...when i got the HCG shot,my follicles were 1.4,2.5 and 2.3......is 2.5 overripe??
5. my insulin pp is 17.51 uIU/ml( 22 -75uIU/ml)
my insulin fasting is 9.04uIU/ml (2 - 25uIU/ml)..
thanx a lot in advance doctor..today is my 23rd day..keeping my fingers crossed..dont want to keep my hopes high though..pls reply all my questions doctor bcos if i hve 2 start taking metformin, i ll start now..heard that it reduces the miscarriage risk for women with pcos..
Thanx again
ANSWER: Hello Pranisha from India,
You have PCO appearing ovaries but that does not make the diagnosis of PCO. You don't need to take metformin (metformin is only for PCOS patients with insulin resistance and you don't have it) and appear to be easily responding to the Clomid, so I would recommend that you keep this course of treatment. 25 mms is a little large and that egg might be over mature, but the 23mm follicle/egg should be good. The 14mm is too small. Because you are trying an natural treatment option, meaning your body as to do all the steps naturally, it may take several attempts to be successful. Clomid is not a magic drug that boosts your fertility. It only corrects the basic problem of ovulation.
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
---------- FOLLOW-UP ----------
QUESTION: hello doctor,
you are right!! clomid is not a magic..got AF on 28th day..and i did some blood works on CD 3.
Here are the results.
FSH 5.58mIU/ml (FOLLICULAR PHASE: 2.5-10.2)
LH 2.85mIU/ML (FOLLICULAR PHASE: 1.9-12.5)
PROLACTIN 9.94NG/ML(NORMALLY MENSTUATING 2.8-29.2)
ADROSTENEDIONE(A4) 1.98 ng/ml (0.47-2.68ng/ml)
ESTRADIOL/OESTROGEN(E2) 50.93pg/ml (FOLLICULAR PHASE 12.5-166pg/ml)
DHEAS 137.60 uG/dl (age 25-34: 98.8-340)
FREE TESTOSTERONE 1.33 pg/ml (0.02-3.09)
PROGESTERONE 0.38 ng/ml (follicular phase -0.2 - 1.50)
SHBG 33.84 nmol/L (26.1 - 110 nmol/L)
TOTAL T3 119 ng/dl (60 - 200)
TOTAL T4 7.80ug/dl (4.5 - 12.0)
TSH 1.38uIU/ml (0.30 - 5.5)
FREE T3 2.87 pg/ml (1.7 - 4.2 )
FREE T4 1.04 ng/dl (0.70 - 1.80)
TESTOSTERONE 20.88 ng/dl (6 - 82)
17-OH-PROGESTERONE 0.53 ng/ml ( follicular phase 0.11 - 1.08ng/ml)
and also i had attached my recent ultrasound with my first question.and doctor,my problem is i m not ovulating regularly and my periods is kinda irregular..sometimes its 35 day cycle and some times 45 day cycle and not more than 45. my hormones appear normal 2 me. and my questions are ,
1)..if there is no problem with my hormones ,what else could be the problem,doctor???
2) is it because of the pco appearing ovaries???
3)is this because of my weight??? 162cms 63kgs
4) and read somewhere if LH is higher than FSH,it is the indication of PCOS. mine is lesser but should it be in 1:1 ratio????
my FSH is higher than LH...WHAT DOEST IT MEAN,DOCTOR?
5) are there any other tests which i hve 2 take???
THANX A LOT, DOCTOR
AnswerHello again,
The fact that you have PCO appearing ovaries and a history of irregular menses makes the diagnosis for PCO. You don't have to be a "classic" PCO with the elevated LH/FSH ratio or increased facial hair or increased weight gain. If you fit any of the criteria, and there is no other explanation for those problems, then PCO is the diagnosis. That means that you have an ovarian dysfunction, where the ovary does not process the hormones correctly, and this leads to ovulatory and infertility problems.
You have had an extensive amount of blood testing. I hope your insurance covered it all because there are tests that you didn't really need. Certainly, if you have not completed a full infertility evaluation, then you should consider having the rest of the testing done. I refer you to my blog for that information since I have written about the complete infertility evaluation and what the tests are for.
If there are no other problems, then the treatment of choice is ovulation induction. You can use Clomid, Femara or injectable medications. I usually will start with Clomid first because it is the easiest to use. You can use up to 250mg per day, which is the dose that most PCO patients need to stimulate the ovaries. 50 or 100mg of Clomid is too low. I would at least start at 150mg and work up from there. You can also use Femara 5.0 or 7.5 mg. Then there are injectables which are more difficult to use and should be done with a fertility specialist only. I have a lot more information on my Blog regarding PCO if you want more info.
I hope that answers your questions.
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
