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Suggest Medication For PCOS When Trying To Conceive
Question: Hello Doctor,
My age is 31 and I have PCOS. I'm trying to conceive since last one year but no luck so far. Initially doctor asked me to try out the natural way based on the hormonal test reports which was found normal. All hormones were within mentioned specified limits in the report. Only one hormone DHEA was on higher side. It was 13.36ng/ml which she told me the reason for having excessive hair on chin but it won’t hinder the conception. She also prescribed me two medicines saying that it will support the pregnancy in case I conceive. Folvite MB to have daily and duphaston 10mg from D16 to D25. She asked to have intercourse every alternate day from D10 to D20. We did everything as instructed.
Since I couldn't conceive, so she asked me to go for the follicular study which I did and found that the ovulation was very slow. Also a subserous fibroid was found in the fundus of uterus measuring 3.6*3.6cm. But doctor told since the growth is on fundus and that too outer side of it, so it won’t hinder the conception. On D23 the size of the follicle was 20x15mm and endometrial thickness was 10.1mm. She gave me an injection Ferrtigyn 5000 IU 1amp on same day to rupture the follicle. She told it would be ruptured in next 24 hrs. so we need to do intercourse that day and then again after one day. Again no luck. The next month she gave me clome 50mg medicine to take from D2 to D6 for induced ovulation and asked me to come again on D10 for follicular study. This time on 21st day the size of the follicle was 20x17mm and endometrial thickness 10.8 mm. She again gave the same injection. Unfortunately I could not conceive again.
This month again she gave clome 50mg and a new medicine metformin for PCOS. Clome was prescribed same as earlier while metformin was prescribed per tablet one day for first week, then step up to 2 tablets in second week and then to 3 tablets in third week. She also asked me to come on 7th day for HSG test to check the tubal status. The report showed full free spillage and she told pelvic condition is absolutely normal. Fortunately this month the ovulation was not slow and the size of the follicle was 21*20 and endometrial thickness 7.9mm on D13. She gave the same injection again and also a medicine estradiol valerate usp 2 mg for 7 days twice a day to increase the endometrial thickness further. We had intercourse consecutively 4days. Once on Tuesday morning, then same day evening injection was given and therefore we had again on Wednesday, Thursday and Friday morning as advised by the doctor.
I have attached all reports (Hormonal test reports and 3 follicular study reports) for your reference and also listing down my complete current medication.
Folic acid (everyday)
Duphaston (D16 to D25)
Clome (D2 to D6)
Metformin (twice a day currently, need to step up to 3 tab from tomorrow 13/12/2014)
Estradiol valerate usp 2mg (for 7 days started on 9/12/2014)
Please guide me if am going on right medication. Is there anything else I need to ask my doctor? My doctor is really good and I trust her but I just want to have a second opinion as she is quite young and not very much experienced. She also told me that if am unable to conceive this time too then I need to get laparoscopy ovarian drilling done which am not willing to. Thanking you for your valuable answer in anticipation.
My age is 31 and I have PCOS. I'm trying to conceive since last one year but no luck so far. Initially doctor asked me to try out the natural way based on the hormonal test reports which was found normal. All hormones were within mentioned specified limits in the report. Only one hormone DHEA was on higher side. It was 13.36ng/ml which she told me the reason for having excessive hair on chin but it won’t hinder the conception. She also prescribed me two medicines saying that it will support the pregnancy in case I conceive. Folvite MB to have daily and duphaston 10mg from D16 to D25. She asked to have intercourse every alternate day from D10 to D20. We did everything as instructed.
Since I couldn't conceive, so she asked me to go for the follicular study which I did and found that the ovulation was very slow. Also a subserous fibroid was found in the fundus of uterus measuring 3.6*3.6cm. But doctor told since the growth is on fundus and that too outer side of it, so it won’t hinder the conception. On D23 the size of the follicle was 20x15mm and endometrial thickness was 10.1mm. She gave me an injection Ferrtigyn 5000 IU 1amp on same day to rupture the follicle. She told it would be ruptured in next 24 hrs. so we need to do intercourse that day and then again after one day. Again no luck. The next month she gave me clome 50mg medicine to take from D2 to D6 for induced ovulation and asked me to come again on D10 for follicular study. This time on 21st day the size of the follicle was 20x17mm and endometrial thickness 10.8 mm. She again gave the same injection. Unfortunately I could not conceive again.
This month again she gave clome 50mg and a new medicine metformin for PCOS. Clome was prescribed same as earlier while metformin was prescribed per tablet one day for first week, then step up to 2 tablets in second week and then to 3 tablets in third week. She also asked me to come on 7th day for HSG test to check the tubal status. The report showed full free spillage and she told pelvic condition is absolutely normal. Fortunately this month the ovulation was not slow and the size of the follicle was 21*20 and endometrial thickness 7.9mm on D13. She gave the same injection again and also a medicine estradiol valerate usp 2 mg for 7 days twice a day to increase the endometrial thickness further. We had intercourse consecutively 4days. Once on Tuesday morning, then same day evening injection was given and therefore we had again on Wednesday, Thursday and Friday morning as advised by the doctor.
I have attached all reports (Hormonal test reports and 3 follicular study reports) for your reference and also listing down my complete current medication.
Folic acid (everyday)
Duphaston (D16 to D25)
Clome (D2 to D6)
Metformin (twice a day currently, need to step up to 3 tab from tomorrow 13/12/2014)
Estradiol valerate usp 2mg (for 7 days started on 9/12/2014)
Please guide me if am going on right medication. Is there anything else I need to ask my doctor? My doctor is really good and I trust her but I just want to have a second opinion as she is quite young and not very much experienced. She also told me that if am unable to conceive this time too then I need to get laparoscopy ovarian drilling done which am not willing to. Thanking you for your valuable answer in anticipation.
Brief Answer:
explained....
Detailed Answer:
hello,
Thanks for contacting healthcaremagic.
I agree with the protocol followed by your doctor but i was not convinced that you were allowed for timed intercourse for 3 cycles in a row.
secondly , if all your ovulation pattern is fine, then has your husband's sperm culture test been done to rule out oligo spermia first , for male infertility. This is important first.
Thirdly if the husband's test is normal , then instead of ovarian drilling you should opt for Intrauterine insemination of sperms to tide over the possible cervical factors which may kill the sperms during intercourse even though you may ovulate.
Ovulation drilling would help in ovuulation only, which you have achieved with clomiphene already, so an IUI is the next step, which is implanting pre washed sperms directly into the uterine cavity on 36 hrs after the fertigyn injection.
YOU may discuss the option with your doctor. You can have three IUI cycles before diagnostic laparoscopy should be considered as per the evidence based protocol.
regards,
dr XXXXXXX
explained....
Detailed Answer:
hello,
Thanks for contacting healthcaremagic.
I agree with the protocol followed by your doctor but i was not convinced that you were allowed for timed intercourse for 3 cycles in a row.
secondly , if all your ovulation pattern is fine, then has your husband's sperm culture test been done to rule out oligo spermia first , for male infertility. This is important first.
Thirdly if the husband's test is normal , then instead of ovarian drilling you should opt for Intrauterine insemination of sperms to tide over the possible cervical factors which may kill the sperms during intercourse even though you may ovulate.
Ovulation drilling would help in ovuulation only, which you have achieved with clomiphene already, so an IUI is the next step, which is implanting pre washed sperms directly into the uterine cavity on 36 hrs after the fertigyn injection.
YOU may discuss the option with your doctor. You can have three IUI cycles before diagnostic laparoscopy should be considered as per the evidence based protocol.
regards,
dr XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Sir,
My husband has already undergone through semen analysis. The latest report of the test which was done in the month of February has been attached for your reference. Request you to please provide your comments on the same.
Would also request you to clarify the below points-
1. '....not convinced that you were allowed for timed intercourse for 3 cycles in a row.' This line is not understood. Does it mean that we should not have had intercourse for consecutively 3 days. If yes, then why?
2. Estradiol valerate usp 2mg-what is this medicine for?
Are there in side effects in the short or long run.
3. Am I on right medication?
4. Is IUI very painful? What are the chances for the same?
Have also attached HSG test report for your reference.
My husband has already undergone through semen analysis. The latest report of the test which was done in the month of February has been attached for your reference. Request you to please provide your comments on the same.
Would also request you to clarify the below points-
1. '....not convinced that you were allowed for timed intercourse for 3 cycles in a row.' This line is not understood. Does it mean that we should not have had intercourse for consecutively 3 days. If yes, then why?
2. Estradiol valerate usp 2mg-what is this medicine for?
Are there in side effects in the short or long run.
3. Am I on right medication?
4. Is IUI very painful? What are the chances for the same?
Have also attached HSG test report for your reference.
Brief Answer:
get an iui done
Detailed Answer:
Thanks for the follow up.
what i meant was you could have been advised IUI after your first menstrual cycle itself when the natural intercourse failed to conceive.thats what is timed intercourse after injection. IUI is safe and more result oriented and not painful .
estradiol tab for 5 days given to grow the endometrium and its safe..
if semen analysis is normal then IUI is the next step in your case in this menstrual cycle.
regards.
dr XXXXXXX
get an iui done
Detailed Answer:
Thanks for the follow up.
what i meant was you could have been advised IUI after your first menstrual cycle itself when the natural intercourse failed to conceive.thats what is timed intercourse after injection. IUI is safe and more result oriented and not painful .
estradiol tab for 5 days given to grow the endometrium and its safe..
if semen analysis is normal then IUI is the next step in your case in this menstrual cycle.
regards.
dr XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Doctor,
Thank you for your valuable advises.
Would like to know the approximate cost of IUI.
One more question - I exercise regularly but is it OK to continue when am not sure whether am pregnant. Should we not do exercises during pregnancy and menstruation.
The machines which I use to exercise are like tread mill, stationary bicycles and elliptical machines. Please guide me.
Thanks !!
Thank you for your valuable advises.
Would like to know the approximate cost of IUI.
One more question - I exercise regularly but is it OK to continue when am not sure whether am pregnant. Should we not do exercises during pregnancy and menstruation.
The machines which I use to exercise are like tread mill, stationary bicycles and elliptical machines. Please guide me.
Thanks !!
Brief Answer:
explained
Detailed Answer:
hello,
an IUI should cost between 1500-2000 including washing of semen sample and insemination inside uterus.
exercises are fine but when you are contemplating pregnancy , you should resort to walking only and no strenuous forms which involve jumping and increased abdominal pressure. Also in early pregnancy , you must not exercise as its gonna be a precious pregnancy for you. you may start light exercises by 14th week of pregnancy .
Thanks.
regards,
dr XXXXXXX
explained
Detailed Answer:
hello,
an IUI should cost between 1500-2000 including washing of semen sample and insemination inside uterus.
exercises are fine but when you are contemplating pregnancy , you should resort to walking only and no strenuous forms which involve jumping and increased abdominal pressure. Also in early pregnancy , you must not exercise as its gonna be a precious pregnancy for you. you may start light exercises by 14th week of pregnancy .
Thanks.
regards,
dr XXXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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