How can a woman with PCOS, fibroid, and failing pregnancy get pregnant?

Hi,

Welcome to icliniq.com.

I understand your concern.

It is sad to know that the tests came negative. The hormone pill Clomid is Clomiphene citrate which affects the estrogen level (female hormone level), so the inner lining of the uterus (endometrial thickness) will be less, so the bleeding will be less. As the urine test was negative, either there was no pregnancy, or the embryo was not good enough to survive or not healthy enough. Let us take the problems one by one:

1. PCOS (polycystic ovary syndrome) is a congenital condition. I mean, it is a genetically programmed condition. You get it from your parents. When you suddenly put on weight, this cholesterol is converted into estrogen hormone. If I may simulate, have not you seen obese men developing breasts and in young obese girls who develop periods at a younger age? They all have high levels of estrogen hormone, a female hormone. In your body, too when fat, which is a store for tomorrow, is more than normal, this is converted to the hormone which tips the balance between FSH (follicle-stimulating hormone) from the brain and the ovarian hormone. Follicle-stimulating hormone, as the name suggests, stimulates follicles from the ovary, but once the follicle is big enough to ovulate, the FSH is suppressed by the same estrogen hormone from the ovary. But when the same estrogen hormone is coming from fat, the brain is confused, and follicle growth stops early at a smaller follicle size and will not rupture, and in the next scan, you will see all these follicles as polycystic ovaries. This is usually associated with obesity, irregular cycles, no periods for a few months, and later heavy periods with clots and fleshy masses, spotting on and off, thyroid abnormality, and prolactin problem indirectly. You develop that extra pad of fat around the mid-segment of the body, especially the waist, thighs, and breasts, with no fat beyond the elbow and knees. Excessive body hair growth, hair fall, a dark shade over the lower half of the face, acne, oily face skin, black skin over the back of the neck, inner thighs, and under the surface of the breast. You may have a family history of diabetes, especially your father or his family. This will not allow ovulation to occur at any time, and so you cannot get pregnant, till treated. It also increases your chances of early pregnancy abortions. But this has a solution. Your weight has to be:

Weight (in kg) = Height (in cm) - 100.

Your expected weight is 63 to 67 kg. Once you reduce weight to the normal range, you will not need any medicine to get periods or to get pregnant, and the pregnancy will be healthy. To reduce weight, I suggest you do the following:

• No fasting, no junk food, fast food, or red meat. Reduce snacks in between meals.
• Have low calories food and high proteins.
• Regular exercise (especially for the waist and hip area), aerobics, yoga, brisk walking (swing your hands well), and try to reduce 2 to 4 kg a month. Do not hurry on weight reduction, as it will be difficult to maintain.
• As soon as you reduce at least 5 kg, you will see changes.
• Due to the hormone imbalance, the inner lining of the uterus is thinner, and bleeding may be enough.

2. Fibroids of that size are better left alone unless you have some symptoms like excessive bleeding or severe pain during periods, or discharge or fibroid projecting into the uterine cavity. A size of up to 5 cm does not need treatment unless the uterine cavity is distorted by fibroid.

3. Age is a significant factor. The best age for pregnancy is 35, not that there is no chance after that. It is just that the chance is reduced. The oldest mother reported is 45 years.

Kindly see if the following checklist of investigations is done:

• Husband: Semen analysis at least two done four weeks apart, preferably in an infertility center (examination done by andrologist), and blood sugar levels.
• Wife: Blood sugar levels and thyroid profile. Ultrasound scans evaluate the uterus, ovaries, and adnexa. Confirming tubal patency is the most important, as the tube is the connection between the uterus and ovaries (the bridge where sperm meets the egg and forms a baby). This is the size of the hair follicle and cannot be seen on scans. Being such a small opening tube can get blocked easily, so check with hysterosalpingography (HSG), an X-ray with dye, sonosalpingography (SSG), a scan with dye, or a laparoscopy.

If all this is done and found normal, nothing can stop a pregnancy. Keeping your age in view, I would suggest you take the steps faster. With all results normal, wait for four to six months only. If still negative, go for IUI (intrauterine insemination). It has four times the pregnancy chances. If up to three IUIs are negative, go for IVF (in-vitro fertilization). After the age of 40 years, the healthy eggs in the ovaries get exhausted, so try to get God's gift before that.

Hope I have cleared your query.

Do write back if any more queries.

All the best.