Are you experiencing problems with fertility or abnormal menstrual cycles, or very irregular cycles.
It is possible that you have polycystic ovarian syndrome (PCOS).
Classically, women with PCOS are described as having irregular menstrual cycles, excessive hair growth, especially on face and chest and problems with being overweight. However, many women with PCOS do not experience all or any of these symptoms. They still may have trouble conceiving, and certain lifestyle modifications like high protein, low carb diet and moderate excercise, and sometimes with the additon of well as medical treatments can restore fertility.
When I see patients with fertility problems or menstrual irregularities, I do a complete hormonal evaluation and an evaulation of the uterine cavity, and if fertility is desired usually the fallopian tubes and the semen parameters. If PCOS seems to be the diagnosis, we start with lifestyle modifications, and also discuss the desire for medications and fertility treatments.
I have had good success with many PCOS patients in restoring ovulation and fertility with this approach.
If you have questions or comments please post, and I will do my best to get back with you.
L. April Gago MD
11 comments:
Thanks for this great blog. I have a question - Are PCOS patients candidates for Metformin?
I have very irregular cycles and my dr. put me on clomid for my last cycle, but non of my follicles were over 10 mm. He thinks I might have PCOS even though I don't not display many of the "typical" symptoms. He thinks Femara might be a good next step. What do you typically see in your patients with PCOS who try Femara>
I was diagnosed with PCOS one year ago and my doctor put me on metformin. After being on BC pills for seven years, i went off of them and after a year my cycle didn't return. I should also mention that i never started my cycle on my own to begin with. That is why my family doctor put me on the pill. I found a OB in trenton and the metformin has helped to restore my cycles. I desperately want to be a mom and i am 28. I went through two cycles of metformin with the lowest dose of clomid with out any luck. I recently found out that the OB treating me for pcos was charged in two states for sexual misconduct against three patients. This on top of my dealing with pcos leaves me wondering who i turn to now. My question is should i find a new OB and continue more cycles of clomid, or should i see a RE such as yourself? You seem to be one of very few RE's in the area.
I see on your website that you mention acupuncture as a part of treatment. Can you tell me about this for people undergoing a fresh IVF cycle? My current RE does not have a postion on whether it helps or hinders, but does not allow acupunture in their office.
After two fresh IVF cycles that resulted in many fertilized eggs, but not many that grew to the blastocyst stage, my RE diagnosed me with premature ovarian failure. What is this and what affect does it have on IVF success rates. Is there anything I can do to improve it?
Hello,
You have been through a lot, with two fresh IVF cycles. It does sound like egg quality may be an issue for you. Unfortunately, sometimes women continue to produce oocytes, and as you have experienced, the oocytes fertilize, but the embryos do not grow and develop normally. This can be due to aging oocytes or poor quality of the oocytes. It is also important to note that it is difficult to determine what portion of failed embryo development is due to sperm issues and not necessarily the oocytes alone.
Have you had normal FSH levels?
How young are you?
What are the sperm parameters of the sperm being used to fertilize your oocytes.
Unfortunately, if it is determined that it is an oocyte problem, there is currently not much available to improve this problem. Optimizing your lifestyle with moderate excercise achieving a normal weight, smoking cessation, following a healthy diet, including lots of antioxidants and moderate alcohol, and pursuing stress reduction may play a role in improving success.
However, overall, if a women really has poor oocyte quality,then donor oocytes result in the best success rates for live birth.
The first IVF cycle (when I was 26) resulted in a twin pregnancy, and one live birth - the twin stopped growing by 8 weeks gestastion.
I am not sure about my FSH levels.
I am currently 30.
Our sperm issues were what initally brought us to doing IVF. The quality was high, but the quantity was low - 2 million I think?
The last fresh IVF cycle we transferred two 5 day blastocysts. That was what we had left after about 20 fertilized eggs. 8 of which we froze, and when thawed for a frozen cycle, 4 made it to day 3, 2 to day 4, but none to day 5.
Hello,
Well, I would definitely not label you with premature ovarian failure if you produced 20 oocytes with your last IVF cycle. You may have oocyte quality issues. I would need to carefully review your IVF records to determine if there was more information regarding the quality of the oocytes noted. Also, it is quite possible that your husband's sperm is also a factor, given the low counts.
Sometimes it can be difficult to determine why the embryos don't develop normally, especially when you produce so many oocytes.
It sounds like you need a second opinion on the most recent advice you have received.
Best,
L. April Gago
Thanks Dr. Gago. I am going to call and make an appt with you today.
Great.
I look forward to meeting you.
L. April Gago MD
Dr. Gago
I have PCOS. Last year underwent IVF. I overstimulated producing in excess of 30 follicles and as a result became very ill. Only 5 were viable. Many months later I had 2 put back. They did not take. Last year I spent a lot of sick time away from work. I would like a second opinion but I don't want to take work off.
Can you do a phone consultation if I send all of my information from the last cycle?
I also want to know what your opinion is about bio-identical hormone replacement therapy.
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