Question"I'm 29yrs old ht-147cms,wt-58kg.My blood result FBS-104ml,PPBs-140ml,urea-24ml,cretinine-1.15ml,uricacid-4.25ml,TSH-1.4(0.4-6.2),LH-12.6miu/ml,FSH-4.3 miu/ml, prolactin-17.6 ng/ml.My both tube patent is normal.i'm having tiny cortical cysts in both ovaries.i tried clomid-50mg for 3 cycles,and letroz-2.5mg for 4 cycles but nothing have helped me.i'm taking metformin-500mg for past 2yrs.again this cycle i'm going to try letroz-2.5mg.after 4 cycles failed with letroz is it possible to fall pregnant in 5th cycle.in my case what is the chance of pregnancy.letroz will help otherwise i should move onto injectables.My husband sperm count-76million/ml. kindly give your reply."
AnswerHello,
Based on your LH/FSH ratio, you have PCOS. I think that the amount of Clomid and Letrozole that you are using is an insufficient dose. PCOS patients tend to be very resistant to these medications so that high dosages are required. I will go up to Clomid 250 mg per day or Letrozole 7.5 mg per day. If this does not work to stimulate the ovaries, then I'll try Clomid 250 mg + Follistim 75 mg in combination. If that does not work then going to pure Folllistim would be the next step. The big problem with the latter is that the PCO ovaries tend to over respond forming too many ovulatory sized follicles. At your age, you would be limited to 3 ovulatory sized follicles (>15 mms). In that case, your cycle would have to be cancelled. For that reason, about 80% of PCOS patients have to go to IVF. That is the only way we cannot remove all the eggs and limit the number replaced.
I hope this helps,
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.
