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Difficulty In Conceiving. Have PCOS. Taken Primolut Nor For FSH And LH Regulation. Treatment For PCOS?

Posted on Tue, 12 Jun 2012

Question: I am a 25 years old married woman ,I have PCO ,I don’t have extra weight ,I took Primolut Nor and regulate my FSH and LH ratio Then I took Clomid for one month and My progesterone test on day 21 was 53 but I didn't conceive. This month I didn't take any medicine but my period missed me for 10 day and when I did the pregnancy blood test the result was negative ... when I asked my doctor she told me that the ovulation is good and I missed my period because of thinking alot of having a baby ...
Would you please tell me what shall I do ,I am sure that I had normal ovulation the month before when I took clomid ..But I am worried for this month ,Did the ovulation occur ? Why my period missed me for ten days ?Do I need to take Clomid again ? Do I need to take Glucophage until I conceive ?Please tell me the ideal treatment for PCO ??
I am a dentist so please advise me with medical Terms
thank you

Answered by Dr. Chetna Jain (3 hours later)

Hi,

PCO is a common problem and causes oligomenorrhea, hirsutism, weight gain, infertility, frontal baldness etc.

A progesterone level of 53 suggests that you ovulated in that particular cycle. The conception rate per cycle of treatment in such a case is about 15%.

Repeat urine pregnancy test after 3-4 days if you do not menstruate this cycle.

With the onset of next cycle from Day 10-12, let your Gynecologist start follicular monitoring and do it till either the ovulation occurs or till no follicle is seen.

If you do not form a follicle naturally then you will ovulation induction with clomiphene citrate regimen. Clomiphene is not used beyond 12 cycles. Hence it should be used judiciously.

It is equally important to know whether husband semen analysis is done or not. If all this is normal try with clomphene alone for 3-6 months.

Please take Folic acid supplements regualrly 400 mcg once a day till you conceive.

There are many different reasons why you could have missed the period, first we check with pregnancy test. The doctor's reason is one amongst and likely. Glucophage regimen trials helps for conception for different reasons. Let your doctor decide on this.

Hope this answers all your questions.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chetna Jain (10 hours later)

Hi Doctor :
thanks for your answer ,Can I ask you more questions please ?
First : you tell me to start follicular monitoring this month,Which is more accurate progesterone test on day 21 or follicular sonar ( follicular monitoring) to decide if the ovulation occurs ??
Secondly : Does the progesterone deficiency lead to delay period and stop the ovulation ,please tell me the relation between progesterone ,period and ovulation ??
thirdly: How can I organize my period if it still not regular ? Does PCO mean that my period will continue irregular for all my life (even the ovulation occurs )??
fourthly : I have two opinions regarding Glucophage , one stressed on taking it until the pregnancy occurs ( because she said that PCO patients have insulin resistance although my insulin test appeared normal ) the second opinion said I should take Glucophage during the Clomid course only BECAUSE I have normal insulin . Which opinion should I follow ??
What should I do for this missed period ,my Gynecologist prescribed Primolut Nor
three pill for three day and then the period will start ,Is that right ?
Sorry for elongation ,please answer me in details because I am really worried ..
Thank you

Answered by Dr. Chetna Jain (13 hours later)

Hi,

Thanks for writing again.

Serum progesterone estimation is indirect evalutaion of ovulation that means in ovulatory cycles prog levels in luteal phase are high>30
TVS(Vaginal scan) follicle monitoring gives direct measurement so that you can be sure which date ovulation occured and other details like endometrial thickness and corpus luteum
your progestrone levels on clomphene suggest adequate levels and no deficiency while without clomiphene you probably dint ovulate
yes prog deficiency leads to delay in cycles as the bleeding is maily estrogen withdrawl only
ovulatory cycles are more painful
Once ovulation occurs there is high prog which drops after 14 days if no conception and periods start
You may not use metformin if you are ovulating without it with normal insulin levels

Wish you good health.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Chetna Jain (10 hours later)

Dear Dr XXXXXXX Jain:
Thank you very very much for this useful answers ...
I will tell you what I understand to do next month following your advices (please orient me and correct the misunderstanding ):
after the period starts I will NOT take Clomid and in the day 10-12 of my cycle I will do TVS to check the ovulation ,and in the day 21 I will do the Progesterone test ....
If the ovulation didn't occur I will have to take Clomid for the next month (December 2011) .....
What about the Progesterone therapy ? Do you think it is effective ??
I will continue taking follic acid until I get pregnant...
Is there any thing more you would advise me ???
Thank you a lot wishing for you more prosperity...

Answered by Dr. Chetna Jain (6 hours later)

Hello again.

you understood things absolutely correct.

Progesterone therapy has no proven role. Please do TVS monitoring without Clomid, if no ovulation.

Take Clomid in next cycle.

Day 21 serum progesterone along with follicular monitoring is optional.

Hope, this helps to solve your query.

Wish you good health.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil