I am 32. I have PCOS for past seven years. Now planning to conceive with Gonadotropin injection and timed intercourse. But my day two blood work shows FSH 4.7, LH 11.2 and prolactin 9. Due to high LH will I get ovulation and if so, how will be the chances of having a healthy pregnancy? Two years back, I got pregnant with Gonadotropin injection but had many complications and pregnancy went on till 35 weeks, then fluid leak and baby passed meconium and was alive only for 15 days, later died at NICU. Three months ago, was pregnant again with Gonadotropin injection but no heartbeat for five weeks, five days. Had missed abortion.
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The LH levels are more than 10 as expected in PCOD, ideally should be less than 7, but still on the lower side. You can continue with the protocol and ideally LH surge occurs at 20 and usually the follicle is matter at 18 mm size. So, pertaining to your query that whether you shall ovulate or not depends on the follow up of LH surge with LH kit from day 10 of your cycle daily to check for positive result. Once positive test is achieved, the follicular scan be done to check for size of follicle and if more than 18 mm, it is mature, then hCG injection can be offered for ovulation.
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Thank you doctor,
But I am in a confusion whether to terminate this cycle and continue with reducing the LH and FSH levels before going for ovulation induction? Or to continue with the cycle and try pregnancy. But my fear is that will I miscarry after conception due to this high LH levels and PCOS. Also, the health of the baby produced like this? Do you have any occurrence of positive outcomes for patients with high LH and PCOS having successful pregnancies? Whenever I ovulated with Gonadotropin injection I got pregnant in the first cycle itself. Now took two injections on day 2 and day 4 and tomorrow day 6 and asked to do a scan on day 8. The doctor said if the cycle does not work we will go for reducing the levels. My worry is about pregnancy if the ovulations went on well this time. I know both the hardship of carrying a complicated pregnancy and a miscarriage.
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As you are already a known case of PCOD, hence LH levels are definitely not going to be normal or <7 as in normal women on day 2. The fact that you have been offered and ovulation induction cycle are because of the fact that you have PCOD, where anovulation has always been the biggest concern, hence stimulators drugs like Letrozole and Gonadotrophin have been used. The quality and maturity of the egg is dependent on FSH levels and not LH levels. FSH levels are normal on day 2 and shall grow with Lupine hCG which shall help in follicular growth improving its quality and maturity with the ongoing cycle. The aim of ovulation induction and timed intercourse is to allow conception. However, further maintenance of pregnancy, or miscarriage due to missed abortion or anembryonic gestation, these are attributed to sperm quality.
The first conception was fruitful but you had preterm rupture of membranes, probably secondary to chronic vaginal infections (we do not know as you have not mentioned, but a common cause) which caused preterm labor. This cannot be attributed to LH or FSH levels as you were PCOD even then. So go ahead with the cycle and preferably if possible opt for IUI cycle rather than timed intercourse which shall improve your chances of conception with quality sperms. You should continue as you have already started it and if this cycle fails then from next cycle you should opt for controlling your PCOD first before opting for conception.
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