PCOS & Ortho Tri-Cyclen: Understanding the Connection

Question
I was recently diagnosed with PCOS, (after many years of suffering with endo also) and we've been TTC for 2 years. I have been taking 1,000mg/day of Metformin to help control the insulin resistance. I have long annovulatory cycles and was recently seen by my doctor who wants to put me on Ortho-tri-cyclen to help get my cycles back under control. She said that women with PCOS have too little of estrogen and that is why I am anovulatory. I have always learned that women with PCOS are estrogen dominant, so now I'm very confused. Which is it? Also, will I see ANY benefit from the birth control pills, after I stop taking them? Will it help to make me ovulate? I have not ovulated since November, which of course makes it difficult to TTC without that important factor.
Thank you in advance.
Laura

Answer
Hi Laura from the U.S.,

First, you are taking an inadequate dose of Metformin, if you have been found to have insulin resistance.  The recommended dose is 1500 mg per day.

Second, your current doctor is incorrect in that OCP's is a treatment to regulate the cycles but will do nothing for your fertility.  Also, the reason why you are anovulatory is because you have an ovarian dysfunction called "PCOS", and that leads to low estrogen, high testosterone levels.  It is NOT the other way around.  Once you stop the OCP's you will go back to your normal anovulatory cycles.  If you want to get pregnant with PCOS, you need to use a medication that will induce the ovaries to ovulate such as Clomid, Femara or injectable medications.  I would recommend that you see a fertility specialist, who understands this problem better and won't waste your time, so that you can get pregnant in the shortest period of time.  Also keep in mind that endometriosis is also a cause for infertility so in essence, you have two problems that are preventing you from getting pregnant.

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