QuestionI was diagnosed with PCOS and put on Metformin in 2007. I took it for over a year lost about a 100 pounds. I was also taking a low dosage birth control for around 7 months. I have no had any type of period without birth control for YEARS now (well over 5) Even when I took Provera before the Metformin.. I had one period and then none after that. I came off the Birth control in late Sept. I had light bleeding for a few days Oct 3rd or 4th. Then light bleeding during early November as well.. The thing was I was in SO much pain. I thought I had a cyst rupture so I went to the hospital for an ultrasound. They found a small cyst that was draining.. which is fine. I would be ok. About a week late I had pain AGAIN. My hospital isn't the best so I went to a new OBGYN ( the one my mom used who did her hyster) ... He said I had been through everything else and suspected I had Endometriosis. Which I had suspected as well.. all my symptoms fit. I had a lap done on November 17th. I was diagnosed with Endometriosis . He cauterized what he could and then gave me a Lupron shot the day of my surgery...
I did more research on Lupron because I was having TERRIBLE side effects. Plus my insurance did not cover it and it would be around $600 a month for me. I just couldn't pay for that or handle the symptoms.
I had what he called a "Lupron Bleed" on December 4th. He said usually about 2 weeks after the shot some have the lupron bleed but do not usually bleed outside of that. I found it weird because I had light bleeding the previous 2 months around the same time. I love him though and trusted the Lupron bleed.
I now am actively TTC (although it wasn't prevented before).. and I am not having periods.. I haven't bled since the lupron bleed. I don't even know if I am ovulating.. I was hoping temping would give me an idea but I just started that.
What would be the next step? I know none of you are doctors but I was hoping to be regular after this surgery and everything... What medications are to be expected? I wanted to wait a month or two to see if I had a cycle ... nothing yet .
The doctor was also kind of pushing for me to have a child asap and I knew we wanted one ... so now we are TTC actively but have no clue when ovulate.. if I ovulate... I don't know if to ask about provera.. clomid... femara.. I am still taking Metformin but a lower dosage since I lost weight..
I just need some guidance on which direction to go if any of you ladies have any advice I would greatly appreciate it.
AnswerHello Nikkol from the U.S.,
First of all, thanks for your question, and I just want to reassure you that I am a Physician and a reproductive specialist at that. You've come to the right place.
Now, it seems there are two factors that might prevent you from getting pregnant. One is PCOD, which is an ovarian dysfunction that lead to the lack of ovulation. Two is endometriosis, which was recently treated but can come back then prevent pregnancy. That is why your doctor wants you to get pregnant as soon as possible. Pregnancy is a great treatment for endometriosis, and if you wait too long, the endometriosis will return and you will have more difficulty getting pregnant.
My recommendation is to see a fertility specialist and undergo ovulation induction. This is a treatment whereby fertility drugs (Clomid, Femara, injectables) are used to induce the ovary to ovulate. This is paired with ultrasounds to determine how you are responding, how many follicles might ovulate and when to trigger ovulation with HCG. Then you would begin intercourse or do IUI's. This is your best treatment option at this point.
Sincerely,
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 facebook and twitter with me at @montereybayivf
