Questionhi there(writing from cornwall,uk)
where do i start!!! basically me mand my partner have been trying to conceive for a few years after a miscarriage in april 08. weve been referred and i have been taking 500mg metformin 3 times a day which i have just increased to four. i have been on these since april, and my cycles dropped from 86days down to 34 days which was july 9th. However, i am now on day 37 . a apreg test showed negative but i do not know if its to early to tell, and why my cycle should increase again.???? ive had blood tests for PCOS which the consultant said were fine so presumuably i havnt got PCOS. I am booked in for a HSG exam on wednesday, but think i will have to cancel because i was meant to book it 10 days after my first day of cycle.
i hope this makes sense to you and hopefully you can give me some advice on what may be happening. Could i be pregnant, and if so, what day should i test on????????
confused and ?????
natasha
Answer
Dr. Ramirez
Hello,
If you have a history of irregular menstrual cycles and elevated insulin levels (the reason for taking Metformin), then you have a diagnosis of PCOD. It is NOT just a blood test diagnosis but a clinical diagnosis. This is a disorder of the ovaries that leads to irregular ovulation or lack of ovulation. In patients that have an elevated insulin level, metformin (an insulin blocker) can help to reduce the level and restore normal ovulatory function. 1500 mg of Metformin is adequate for this. Increasing the dosage doesn't do much. Only 50% of PCOD patients have elevated insulin levels. You may need more than the metformin, such as ovulation induction treatments with fertility medications. In addition, there could be something else going on as well so you should undergo an infertility evaluation. I would recommend that you consult a fertility specialist, not a general Ob/Gyn.
In terms of the possibility of pregnancy, it might be too early for a home pregnancy test but not for a blood pregnancy test. In terms of scheduling the HSG, you should consult your doctor so that he/she can induce a period for you then schedule.
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.
