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Suggest Treatment For Infertility When Suffering From PCOD
Question: Hi Doctor. I am seeking treatment now for regulating my menses and I just need a second or even third and fourth opinion on my problem.
I am 30 years old with 1 normal ovary and 1 polycystic ovary based on my most recent transvaginal ultrasound last September 29. I was diagnosed with PCOD/PCOS at the age of 25 and initially prescribed with Metformin. My menses have been irregular since then. I was eventually given Gracial birth control pills for around 9 months last 2013. I think it is also relevant to mention that I developed Type 2 Diabetes last May 2012. I have been on Metformin and Linagliptin from 2012 up to end of 2013.
When my fiance and I decided to try for a baby January this year, I stopped my birth control pills. My menses still regularly arrived every month but cycles have been a bit long with an average of 35 days. I also stopped Metformin last January because my endocrinologist was apprehensive about me continuing even the Metformin in the event that I get pregnant. So I just requested for insulin, Mixtard 30.
But this September I read a lot of articles saying that Metformin actually helps women with PCOS because it somehow has a good effect in terms of ovulation. It is off label of course to use Metformin to aid in ovulation but since Metformin is cheaper than Insulin and I can tolerate the gastro side effects anyway, I decide to go back to Metformin, In fact, my blood glucose is in even better control than when I was on Insulin. My hba1c has always been in the normal range anyway for the past 2 years.
My question now is this. Do you think it is okay to go on the conservative side of fertility intervention like lifestyle changes first and weight loss (I am considered obese). I am also willing to have my OB regulate my periods with whatever hormonal treatments she deems best. And also Clomid or any ovulation inducer. My fiance is also scheduled to undergo semen analysis so we can also rule out any problems from his side if ever. I just felt very put off by this other OB Gyn here in Healthcare Magic who told me to do FSH induction and IUI because 9 months of trying is long already. Is that true? She never even asked me how many times my fiance and I have intercourse. We still do not live together so we get the chance to have sex around once a week on average, sometimes 2 times. So I am also considering maybe we have not nailed the timing yet and of course we will wait for his semen analysis and I have to lose weight too. Isn't IUI a bit too advanced given my situation? I still have time right? Because I have read many medical related books and sources that say women under 35 can try for up to a year without seeking medical intervention. I am determined to lose weight and eat healthy before I get married middle of next year by which time my partner and I will be living under one roof and by then semen analysis results would be determined and any problems will be addressed too.
I am 30 years old with 1 normal ovary and 1 polycystic ovary based on my most recent transvaginal ultrasound last September 29. I was diagnosed with PCOD/PCOS at the age of 25 and initially prescribed with Metformin. My menses have been irregular since then. I was eventually given Gracial birth control pills for around 9 months last 2013. I think it is also relevant to mention that I developed Type 2 Diabetes last May 2012. I have been on Metformin and Linagliptin from 2012 up to end of 2013.
When my fiance and I decided to try for a baby January this year, I stopped my birth control pills. My menses still regularly arrived every month but cycles have been a bit long with an average of 35 days. I also stopped Metformin last January because my endocrinologist was apprehensive about me continuing even the Metformin in the event that I get pregnant. So I just requested for insulin, Mixtard 30.
But this September I read a lot of articles saying that Metformin actually helps women with PCOS because it somehow has a good effect in terms of ovulation. It is off label of course to use Metformin to aid in ovulation but since Metformin is cheaper than Insulin and I can tolerate the gastro side effects anyway, I decide to go back to Metformin, In fact, my blood glucose is in even better control than when I was on Insulin. My hba1c has always been in the normal range anyway for the past 2 years.
My question now is this. Do you think it is okay to go on the conservative side of fertility intervention like lifestyle changes first and weight loss (I am considered obese). I am also willing to have my OB regulate my periods with whatever hormonal treatments she deems best. And also Clomid or any ovulation inducer. My fiance is also scheduled to undergo semen analysis so we can also rule out any problems from his side if ever. I just felt very put off by this other OB Gyn here in Healthcare Magic who told me to do FSH induction and IUI because 9 months of trying is long already. Is that true? She never even asked me how many times my fiance and I have intercourse. We still do not live together so we get the chance to have sex around once a week on average, sometimes 2 times. So I am also considering maybe we have not nailed the timing yet and of course we will wait for his semen analysis and I have to lose weight too. Isn't IUI a bit too advanced given my situation? I still have time right? Because I have read many medical related books and sources that say women under 35 can try for up to a year without seeking medical intervention. I am determined to lose weight and eat healthy before I get married middle of next year by which time my partner and I will be living under one roof and by then semen analysis results would be determined and any problems will be addressed too.
Brief Answer:
PCOS+type-2 DM , planning conception..advised
Detailed Answer:
hello,
Thanks for contacting healthcare magic.
Firstly i really appreciate your concern about your situation and having been so well informed.
lets take it step by step from here:-
1. 30 yrs old , unmarried , nulligravida, with history of PCOS not on birth control pills since XXXXXXX 2014 + type -2 diabetes diagnosed , on metformin 750mg 3x a day since september 2014 again. Better controlled achieved with metformin than with mixtard 30/70 and better tolerated. HbA1c levels of 6.2 are under control.
2.Cycles are regular now since XXXXXXX 2014 , 35 days cycle.
3. Trying to concieve since XXXXXXX 2014. but not living with partner and infrequent and untimed intercourse.
Concerns= 1.should you continue metformin or shift to insulin?
2. should ovulation induction drugs like FSH be resorted to already or timed intercourse is preferable at this stage or IUI ?
3. regularisation of cycles and weight loss by marriage next year?
advise:-
1. In cases of PCOS, as you know the lady gets oligomenorrhoeic cyles ( ie 35-60day cycle), along with hirsutism and polycyctic ovaries. as you were diagnosed at the age of 25 and continued the treatment till XXXXXXX 2014 and presently off pills and still getting a 35 day cycle, it is still healthy. But generally it is seen in a lady who is obese and PCOS , tend to get deranged cycles again after 6 months of gap unless weight and dietary modification is practiced. A state of insulin resistance is achieved during PCOS which is finally manifested as type-2 diabetes if remain uncontrolled ( as in weight control and regularity).
2. Metformin usage for controlling insulin resistance is fine and literature supports its use regulating ovulation in cases of infertility and PCOS. Insulin should always be resorted to if the sugar values are deranged and if the HbA1c is > 7.5. else metformin can be safely continued even till 14-16 weeks post conception without any harm to the fetus and after that based on the blood sugar profile the lady can be either manged by diet, glibenclamide or insulin throughout pregnancy ( a set protocol for management of diabetes in pregnancy).
3. A couple is termed eligible for infertility treatment only when they have stayed together regularly for atleast whole one year without breaks and having 4-5 times intercourse per week ( well aware of fertile period) and yet not able to conceive. Only such patients are to be evaluated initially with follicular monitoring , sperm analysis for males , and then if required ovulation induction ( with clomid or fsh) and subsequently an IUI.
So , in my opinion,
you dont fit the criteria for infertility yet as you dont stay with your partner and its just 9 months that you both have been trying.
Nevertheless, its helpful to get the sperm analysis for the partner done to rule out any form of decreased sperm count or abnormality.
Also, you need to be aware of your fertile period and you have to time your ovulation every cycle with the help of easy to use ovulation detection kits ( LH kit) available off the counter. IN a 35 days cycle ovulation should occur by 15-17th day, so you can start testing from 14th day of your cycle till it comes positive. once positive , then t indicates LH surge, after 36 hrs of which Ovulation shall occur. so you can have intercourse then and can time it easily.
Lastly regarding , metformin. you may continue it as prescribed daily and focus on weight loss. Duphastan can be avoided and required only if your periods dont resume on their own by 45 days. And please continue Folic acid 5mg daily, it shouldnt be stopped. Blood sugar profile SHOULD be done every 3 weekly to keep a check on your sugar values.
in case of further queries, feel free to contact .
regards,
Dr.Sameer Kumar
PCOS+type-2 DM , planning conception..advised
Detailed Answer:
hello,
Thanks for contacting healthcare magic.
Firstly i really appreciate your concern about your situation and having been so well informed.
lets take it step by step from here:-
1. 30 yrs old , unmarried , nulligravida, with history of PCOS not on birth control pills since XXXXXXX 2014 + type -2 diabetes diagnosed , on metformin 750mg 3x a day since september 2014 again. Better controlled achieved with metformin than with mixtard 30/70 and better tolerated. HbA1c levels of 6.2 are under control.
2.Cycles are regular now since XXXXXXX 2014 , 35 days cycle.
3. Trying to concieve since XXXXXXX 2014. but not living with partner and infrequent and untimed intercourse.
Concerns= 1.should you continue metformin or shift to insulin?
2. should ovulation induction drugs like FSH be resorted to already or timed intercourse is preferable at this stage or IUI ?
3. regularisation of cycles and weight loss by marriage next year?
advise:-
1. In cases of PCOS, as you know the lady gets oligomenorrhoeic cyles ( ie 35-60day cycle), along with hirsutism and polycyctic ovaries. as you were diagnosed at the age of 25 and continued the treatment till XXXXXXX 2014 and presently off pills and still getting a 35 day cycle, it is still healthy. But generally it is seen in a lady who is obese and PCOS , tend to get deranged cycles again after 6 months of gap unless weight and dietary modification is practiced. A state of insulin resistance is achieved during PCOS which is finally manifested as type-2 diabetes if remain uncontrolled ( as in weight control and regularity).
2. Metformin usage for controlling insulin resistance is fine and literature supports its use regulating ovulation in cases of infertility and PCOS. Insulin should always be resorted to if the sugar values are deranged and if the HbA1c is > 7.5. else metformin can be safely continued even till 14-16 weeks post conception without any harm to the fetus and after that based on the blood sugar profile the lady can be either manged by diet, glibenclamide or insulin throughout pregnancy ( a set protocol for management of diabetes in pregnancy).
3. A couple is termed eligible for infertility treatment only when they have stayed together regularly for atleast whole one year without breaks and having 4-5 times intercourse per week ( well aware of fertile period) and yet not able to conceive. Only such patients are to be evaluated initially with follicular monitoring , sperm analysis for males , and then if required ovulation induction ( with clomid or fsh) and subsequently an IUI.
So , in my opinion,
you dont fit the criteria for infertility yet as you dont stay with your partner and its just 9 months that you both have been trying.
Nevertheless, its helpful to get the sperm analysis for the partner done to rule out any form of decreased sperm count or abnormality.
Also, you need to be aware of your fertile period and you have to time your ovulation every cycle with the help of easy to use ovulation detection kits ( LH kit) available off the counter. IN a 35 days cycle ovulation should occur by 15-17th day, so you can start testing from 14th day of your cycle till it comes positive. once positive , then t indicates LH surge, after 36 hrs of which Ovulation shall occur. so you can have intercourse then and can time it easily.
Lastly regarding , metformin. you may continue it as prescribed daily and focus on weight loss. Duphastan can be avoided and required only if your periods dont resume on their own by 45 days. And please continue Folic acid 5mg daily, it shouldnt be stopped. Blood sugar profile SHOULD be done every 3 weekly to keep a check on your sugar values.
in case of further queries, feel free to contact .
regards,
Dr.Sameer Kumar
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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