Q. I am having PCOS, and trying to conceive for eight months. What is the treatment?

Answered by Dr. Sameer Kumar and medically reviewed by Dr. Nithila A

 

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Hello doctor,

I am 33 years old. I have been trying to conceive for eight months from now. I have monthly periods and positive OPKs and BBT shifts, but periods are also very light, basically spotting. I had an Ultrasound which showed a few cysts, had mildly elevated testosterone, normal LH and FSH, normal estrogen, low progesterone. My PCP is not convinced. I have PCOS but I am wondering if that is still a possibility and what I should anticipate for treatment in the future (clomid vs. progesterone therapy, etc.)?


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Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome to icliniq.com.

The fact that you are getting positive OPKs each cycle indicates that you have an anovulatory cycle or in simple terms that you are ovulating regularly. PCOD (polycystic ovarian syndrome) cannot be diagnosed alone with just small cysts in ovaries, rather one should have around 10 to 12 multiple small subcenterimetric follicles lining the periphery of the ovary during midcycle scan, one should have featyres of clinical hyperandrogenism like acne, hirsutism (excessive facial and body hair), acanthosis and most importantly oligomenorrhoea or irregular menses.

Testosterone alone does not justify the diagnosis. However, if o e needs to be sure, then AMH (ante Mullerian hormone) test can be done, which is more than four indicates PCOD. As mentioned that you are on thyroid medications, I believe your TSH levels are less than five. Please share your ultrasound and hormonal profile reports for review.

Now, it would also be essential to check for your partner's semen analysis for quality and quantity of sperms. I am not sure if you have any kids before or not as you have not mentioned, but if you do not yet, then semen analysis of your partner would be mandatory, as your reports are relatively normal. Progesterone deficiency can be treated, and even Clomid can be contemplated only of the male infertility factor has been ruled out first.

 

Thank you doctor,

I have attached all of my results. I have been on the Synthroid for years since my thyroidectomy, and it has never seemed to be an issue. Admittedly, some of my tests were saliva tests (the progesterone, estrogen, testosterone). Not sure how valid that makes them. We also did a home sperm test, which seemed to show an adequate sperm count for my husband. One more question I had, the ultrasound says my uterine thickness was 4 mm, and it was done around the time of my ovulation. Is that thin?

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity).

1. You have an early LH (luteinizing hormone) surge as on same day LH is high, and FSH is normal. This causes immature folliculogenesis and first ovulation, which are incapable of forming corpus luteum to secrete adequate progesterone and hence the thin endometrial ling as well.

2. Testosterone levels are high borderline.

3. Progesterone levels are low for day 21 of cycle indicates less production by corpus luteum of no ovulation at all.

4. Presence of small anterior wall fibroid which would not affect pregnancy at present or likely cause of infertility but is expected to increase with cycles.

5. Thin endometrium due to poor estrogenisation of the endometrium during the cycle.

Keeping all in mind, this does not indicate PCOD, but it does indicate a hormonal imbalance between early LH increase, low FSH, and low progesterone. Please get AMH levels done as well.

You can and should be treated for hormonal imbalance with low dose combined OC pills for three cycles first before planning pregnancy, which would be mandatory in your case, unless you wish to hurry up for pregnancy, then ovulation induction can opt again with estrogen and progesterone support during the cycle and possible recombinant FSH injections if required. Success rate universally remains 35 to 40 % only, even with assisted techniques.

 
 
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