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Dr. Andrew Rynne

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Suggest treatment for PCOS

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Dr. Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1656 Questions

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Posted on Fri, 19 Aug 2016 in Women's Health
Question: Hi we have been trying to have child but as we are both working in different state so we are not able to live more than 2-3 month continuously . as she had irregular monthly cycle earlier and after treatment it have almost timely now but the egg is not healthy after taking HMG injection it's size in increased ,injection was also given for bursting of egg and this process has been done 4-5 times and after getting good egg size also still could not got pregnant what may be problem,may be egg not rapturing how it can be overcome please suggess....
doctor
Answered by Dr. Sameer Kumar 26 minutes later
Brief Answer:
primary infertility + ? PCOS

Detailed Answer:
Hello,
Thanks for the query to hcm,
with the history it is likely that she is a patient of PCOS or polycystic ovarian syndrome where ovulation is erratic and had to be induced with meds. I suggest that she should be planned for controlled ovarian stimulation and a IUI ( intrauterine insemination ) cycle next time. That would remove the cervical factors of infertility and increase her chances of pregnancy. Eggs don't rupture if the progestognenic environment in ovary is higher due to PCOS. Ideally pcos should be treated and controlled first and then conception should be planned.
Please send her hormonal profile report and latest ultrasound pelvis for review and further advise . Also what medications were given to her for induction and during the cycle.
Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Sameer Kumar 46 hours later
Thanx for the reply...
I want to ask what we can do for rupture of eggs...and i couldn't tell you earlier that she produce many small eggs that's why size of eggs are not good,
please suggest any other method. Her eggs came to good size upto 17-18 days from MC if taken medicine or HMG injection.As per our treatment it is almost sure that after getting good size still she couldn't got pregnant is due to not rupturing of eggs so please throw some light regarding this is there any surgery required...
doctor
Answered by Dr. Sameer Kumar 6 hours later
Brief Answer:
answered

Detailed Answer:
Hello,
I believe eggs are being ruptured by HMG injection and thats fine simply because you have opted for ovulation induction protocolled ideally PCOS should be controlled first and then conception should be tried. The chances of conception with natural timed intercourse after HMG injection or even other wise remains only 30-35% , so it is common for cycles to fail. The protocol for dealing with primary infertility du to PCOS is 1 DUMMY CYCLE, 3 OVULATION INDUCTION CYCLES with Timed intercourse or IUI , then diagnostic laparoscopy + hysteroscopy , then 3 cycles of ovulation induction again before the patient is referred for IVF.
So you should carry on with another 2 cycles. Please submit your latest ultrasound report and the medications which she has been on since last 2 cycles.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar 19 hours later
Hi, I have provided some attachments. Please review them.

Dear sir, as you asked to upload report and medicine details
i have uploaded please go through this and give your valuable suggestion as it have already 2 year passed for taking treatment but no result even getting good size egg also waiting for your reply
doctor
Answered by Dr. Sameer Kumar 5 hours later
Brief Answer:
answered

Detailed Answer:
You need to get a fresh hormonal profile done with FSH , LH, PROLACTIN AND AMH LEVELS.
rEST MEDICATIONS ARE FINE AND ovulation induction with IUI would be the next best option for you hence.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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