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Planning to conceive. Having PCOS and elevated AMH levels. Can I ovulate naturally?

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Infertility Specialist
Practicing since : 2002
Answered : 673 Questions
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Hi,
We are planning to conceive, and in respect to same, i got diagnosed myself with some reports. Wherein i have been diagnosed with polycystic ovaries. AMH level is high with 9.64. All other blood tests including thyroid and sugar levels are normal.There are 2-4 mm multiple folliciles in the ovaries, however there are no mass/cysts gathered yet.
All others related things are normal.
I wanted to know, that whether i can ovulate regularly., naturally or with medication,if yes then how.? What medicines are prescribed for this.?. Further how much time this treatment takes, to get ovulation normal and conceive
Posted Tue, 19 Nov 2013 in Infertility Problem
 
 
Answered by Dr. Dattaprasad 38 minutes later
Brief Answer:
Ovulation induction can be done with medicines.

Detailed Answer:
Hi,
Welcome to XXXXXXX
I just want to know whether your menses are regular.
If menses are absolutely regular, you can disregard ultrasound report as you might be already regularly ovulating.
In case of other possibility (that is irregular menstrual cycles), you need simple ovulation induction medicines. Normally in such cases we start with clomiphene citrate (50/100mg) starting from day 2/3 of menses for 5 days & monitor follicular study for growth of follicle & ovulation. In case you make no follicle in first cycle, dose can be increased in second cycle & monitoring done.
Other option is to add Inj. FSH to clomiphene if follicle is not growing, which rarely happens.
Third option is to undergo laparoscopic ovarian drilling. After laparoscopic ovarian drilling, there is 50% chance that ovulation may become regular without need for medicines. In another 50% cases, it will reduce the dose of medicines required for ovulation induction.
If you can tell few points about yourself, I can guide for further treatment.
1. How are your menstrual cycles.
1. How many months/years you are trying for pregnancy?
3. Whether husband's semen test has been done, & if done what is the report?
4. Whether you have done any tubal patency test like sonosalpingography/hysterosalingography/laparoscopy. If yes what was the report?
5. Did you experience symptoms suggestive of pelvic infection like foul smelling vaginal discharge with fever in past?
6. What treatment you have taken till now?

Answers to above mentioned questions will help me guiding you for exact treatment.

Awaiting your reply.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Planning to conceive. Having PCOS and elevated AMH levels. Can I ovulate naturally? 4 hours later
1. How are your menstrual cycles.
Answer:-. My cycles till now have been regular, almost every 28 days. However there were periods of 1.5-2 days observed since 6-7 months, and spotting on 3rd-4th day. first 1.5 days, there is considerable amount of bleeding.
Further, i have vaginal discharge almost all days of the month. I was under impression, that regular vaginal discharge, is one of the symptoms of being ovulating, however PCOS have now made me worried on this part.

2. How many months/years you are trying for pregnancy?
Answer:- We started trying since one month.


3. Whether husband's semen test has been done, & if done what is the report?
Answer:- He is yet to undego test. His test would be done by this weekend.

4. Whether you have done any tubal patency test like sonosalpingography/hysterosalingography/laparoscopy. If yes what was the report?
Answer:-No such test done

5. Did you experience symptoms suggestive of pelvic infection like foul smelling vaginal discharge with fever in past?
Answer:- Reports do not indicate any pelvic infection, as i have done sonography of both abdomen and pelvis. However, urine reports shows 8-10 pus cells with deposits and bacteria present. There is trace of occult blood also in the report. Report day was ideally my 5th day of menstrual cycle.


6. What treatment you have taken till now?
Answer:- No treatment undergone till now.



 
 
Answered by Dr. Dattaprasad 38 minutes later
Brief Answer:
You probably need no treatment.

Detailed Answer:
Hi,
Welcome back.
As your menstrual cycles are regular, its highly likely that you are ovulating regularly. You just need to confirm the same by either ultrasound follicular monitoring OR better by one blood test (Serum progesterone) done on 21st day of your cycle (The day of start of menses is counted as day1). If ovulation is confirmed, you can disregard USG findings.
Chance of pregnancy in one cycle of unprotected sex is 25-30%. Since you are trying just since one month, you have not got enough chance to prove fertility, you can skip detailed infertility evaluation.
If you are very anxious, three important tests to make sure that there is nothing wrong that can prevent conception are:
1. Husband's semen analysis.
2. Check your ovulation as described above.
3. Checking tubal patency. (You can defer it to be done later, as there is nothing to suggest that your tubes can be blocked. (No past episode of pelvic infection)).
Hope this helps you in decision making & avoiding costly unnecessary investigations & treatment.
Let me know if you have other concerns.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Planning to conceive. Having PCOS and elevated AMH levels. Can I ovulate naturally? 7 minutes later
Hi doctor,

First of all thanks for your answers, as they are pretty explanatory and counselling in nature.

I hope that things are in place. Still worried why there are PCOS? and high AMH levels?...
Hence would like to go for the Serum progesterone test, just for my consolation

Would keep you posted on this....

Thanks once again

 
 
Answered by Dr. Dattaprasad 12 minutes later
Brief Answer:
Thanks.

Detailed Answer:
Hi,
Welcome back.
Polycystic ovaries on ultrasound can be found in 25% of normal women. You need not worry for that.
Regarding high AMH, it indicates good ovarian reserve, which is a good thing.
Just make one thing sure, please don't put on weight as obesity can lead to ovulatory problems. Also do at least 30 minutes of exercise daily, which will negate any bad effect polycystic ovary can have on ovulation.
Wish you good health.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Planning to conceive. Having PCOS and elevated AMH levels. Can I ovulate naturally? 2 days later
Hello doctor,

Disturbing you once again.
I had done serum fasting insulin test done, and it shows 6.5 as observed values.
Is this normal, especially with the relation of PCOS being detected.
Further, does this indicate anovular cycles.?

 
 
Answered by Dr. Dattaprasad 22 minutes later
Brief Answer:
Insulin level is normal.

Detailed Answer:
Hi,
Welcome back.
Your serum fasting insulin level is normal. Insulin level doesn't indicate anovulation. Ovulation can be predicted by serum progesterone as I told already.
Regards.
Above answer was peer-reviewed by
 
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