I am a 23-year old female, and I am unable to ovulate and conceive. I have irregular periods, hormonal imbalance, and I am hard to keep weight under control. I am currently having spotting once or twice a week. I am trying to conceive for one and a half years now. Menstruation started at the age of 10 and was always irregular. Height is 5'3'' feet. I had a healthy weight for most of my life, and periods were always irregular, skipping two to six months without a period and sometimes regular. For the last five years, I have gained 70 pounds gradually, along with excessive hair growth on the chin and face and other parts of the body. Periods remained irregular and heavy with large clots. Depression and anxiety worsened and are still present. Occasional pains in the pelvic area on the sides, not one side specifically. I sometimes get positive ovulation tests. Recently I had bleeding for 10 days straight, and it was odd for a period, as it was light and orange or brown. I have also been diagnosed with Factor V Leiden (heterozygous), acquired hypothyroidism. In addition, I was diagnosed with PCOS. The endometrial stripe is 10 mm with small follicles on both ovaries. DHEA-S is 695.5 µg/dL, CT of the abdomen showed no tumor or mass on adrenal glands or other significant findings; Vitamin D is 19 ng/mL. I have attached the ultrasound report. I have tried birth control, but Progesterone made me feel more depressed, and I cannot take Estrogen due to Factor V Leiden diagnosis. Can you please give me a second opinion on pelvis ultrasound for fertility along with other laboratory work?Current medications:
Tablet Levothyroxine 100 mcg tablet for elevated TSH in the past of 4.2 mIU/mL.
Tablet Sertraline 200 mg for anxiety and depression.
Tablet Dextroamphetamine-amphetamine 20 mg for ADHD.
Tablet Folic acid 1 mg tablet (folate level 3.9 ng/mL).
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I am keeping in view that you are a diagnosed case of PCOD (polycystic ovarian disorder), hypothyroidism, Factor V Leiden mutation (genetic mutation that causes abnormal clotting), and ADHD (attention deficit hyperactivity disorder).
PCOD needs to be addressed first to allow you to ovulate regularly. Still, with Factor V Leiden mutation, your propensity towards thromboembolism would be increased, and this alone can become an individual cause for possible recurrent miscarriages in future post-conceptions. So you would have to be on anticoagulants post-conception.
I suggest that tablet Sertraline and tablet Amphetamine that you are on for ADHD need to be discontinued. Psychobehavioural therapy would need to be reported instead as these medicines are not pregnancy safe.
You need to continue thyroid medication to keep hypothyroidism under control.
As you are trying to conceive, I suggest we control ovarian stimulation with tablet Clomiphene citrate followed by an hCG trigger to initiate ovulation and further timed intercourse or an IUI (intrauterine insemination) procedure for conception.
Kindly share your ultrasound and other reports for review.
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