QuestionHi doc,
I am 26 yrs female married for 8 months.We are trying to conceive without any success till now.
My blood work shows mild PCOD.
The test results are as follows:-
FSH - 4.5
LH -6
testosterone, Free - 6.97 (which my RE says, is borderline)
TSH - 2.5 (within range)
GTT also normal
No IR
And my day 22 s-progestrone is 13ng\ml .
My periods have always been very regular and I weigh about 52 kg and dont have much problem except increased facial and body hair and acne earlier.
Transvaginal U/S showed enlarged right ovary with 2 cysts of 2-3cm.Left ovary is normal with a developing follicle of 11 mm on day 14.
Please suggest is it all normal with the s-progestone level given , as i guess this value is enough to trigger ovulation.
And how should I go ahead with the treatment following the tests . the two large cysts are haemorrhagic and very old cysts.
Earlier I had typical polycystic appearing ovaries , after taking homeopathic medicine for 8-9 months, only 2 large cysts are left on rt ovary and my left ovary has become completely normal.
Please suggest the best way to go ahead with it.
Thanks and regards,
Ria
AnswerDear Ria,
Thank you for your question. Where are you writing from?
It sounds like you have undergone a pretty good evaluation, but the findings are not necessarily consistent with PCOS. First, PCOS is defined by an LH/FSH ratio of at least 3:1. You don't have that. The remainder of your tests are normal. In fact, the day 22 progesterone (midluteal phase progesterone) is consistent with ovulation. That is it shows that you are ovulatory. I presume your cycles are regular.
The fact that you had PCO-type ovaries, acne and increased facial hair is not necessarily diagnostic.
The two "old hemorrhagic cysts" are a little concerning. Physiologic cysts do not persist. They go away after each cycle. If these cysts have been there for a while then it is possible they are endometriomas. These are endometriotic cysts within the ovary and indicate a Stage III or Stage IV endometriosis. In these stages, there is often lots of scar tissue within the pelvis and this scar tissue will block the passage of the ovulated egg into the tube. In addition, this causes a chronic inflammation of the pelvis that interferes as well. A laparoscopy would be indicated in this case to remove the cysts and evaluate the pelvis further. Endometriosis can only be diagnosed with laparoscopy.
8 months is not long enough to make a diagnosis of infertility in your age group. You should continue trying for at least another 4 months. However, if your cycles are irregular, an indication of PCOS, then you may need fertility medications to help you to ovulate.
I hope this answers your questions.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
