#ovulation dysfunction

At my first appointment (2 weeks ago) was my general consultation.  We (My husband and I) essentially sat in the RE’s office and talked about both of our medical histories, how long I had been on birth control, why I went on it in the first place, abnormal symptoms, our sex life, the whole gamut. She was very warm and welcoming and it was such a relief to be taken seriously and not shrugged off because I’m not 5’8 and 85 lbs. I explained to her my “soft” diagnosis of PCOS prior to starting BCP many years ago and that I was most positive I did have it.  My prior diagnosis was from a pediatric endocrinologist at Duke when I was about 15.  She had never heard of it before, and was pretty much a dingbat who needed to retire.  A decade later, it has been confirmed. She explained to us about the normal cycle, the hormones, how they respond to each other, et cetera, which of course I’ve already done loads of research on but it was great for my husband to hear about more in-depth.  She explained how PCOS throws everything out of whack and the LH just kind of does whatever the hell it wants to do, and thus doesn’t stimulate ovulation, and the rise and fall of progesterone that causes you to menstruate.  She explained the courses of treatment (Metformin, Provera, Clomid, Femera, injectables, etc), and the pros and cons and normal routes of each.  After our brief anatomy and biology lesson, she took me back for an ultrasound.  What I LOVED was that SHE was the one who did the ultrasound.  Not a sonographer, but the actual doctor. She pointed out everything, explained the shape of my uterus (normal, not bicornuate as far as she could tell) ovaries, etc.  We saw the cysts stacked up in my ovaries and there was no evidence of ovulation (I was CD 29 on the day of the consult).  PCOS was essentially confirmed from that point.  I then had a bunch of blood work drawn and got to play the waiting game until the follow-up. She left us with information to think about how we wanted to proceed as she was willing to work with us on whichever route we felt comfortable with.

So that brings us to the consult/lab work follow-up which we just got back from.  We went over the lab work first and I have smaller than typical blood cells.  MCV and MCH (mean corpuscular volume and hemoglobin) were super low so she ran additional testing today for thalassemia (from what she said, an inherited hemoglobin deficiency essentially resulting in anemia), and a full hemoglobin workup.  It makes sense because often I get deferred from the Red Cross from donating blood because my hemoglobin wasn’t high enough. My I’s and T’s are finally being dotted and crossed, and that does please me. Fasting glucose was perfect.

My metabolic panels are beautiful.  My cholesterol is stellar, the good and the bad are where they are supposed to be.  My triglycerides were at the top of the normal range, and she said they are probably fine and it was due to a recent fatty meal.

My AMH (Anti-Mullerian Hormone) is 3.1 ng/mL which is FANTASTIC.  This number loosely refers to the ovarian reserve and the overall health of my ovaries.  In PCOS The AMH levels can be deceivingly high and need to be confirmed with the transvaginal ultrasound I had at the last appointment to conform the antral follicle count which is also high. So that’s good news.

Testosterone is elevated but still within the upper limits of the normal range, thus pointing again towards PCOS. A1C is also within the normal range of limits, and not pre-diabetic. Thankyoujesus.

So, the diagnoses are PCOS and ovulation dysfunction.

  TL;DR Where we’re going from here:

My husband and I have chosen to take a little bit more conservative route.  I will be starting on metformin very slowly and going in for monitoring every 2-3 weeks.  My a1c is not very high so they want to monitor me closely to make sure that I don’t become hypoglycemic. Hopefully it will help me lose a few pounds, too.

I was given a prescription for Provera to induce a “bleed.” (Today is CD 44) I should get a “period” by CD60.

There is a 50% chance of ovulation and cycle regulation on metformin.  I should see results in as few as 2-3 weeks.  We decided to stick with Metformin until the end of the year.  If I am not ovulating with Metformin at that point, we will be adding Clomid to the mix. Multiples run in nearly every generation maternally, so my husband and I didn’t want to raise our already 8% chance of multiples (on clomid) even higher without giving the metformin a chance, first.  Should I need clomid, I will start on the lowest dose, and come in for monitoring every month to check for ovulation.

 If I am in-fact ovulating but I have not conceived after 2-3 ovulatory cycles, we will go in for anatomy testing.  SA for the husband, and HSG and saline sonogram for me to start. If those tests come out clear, we will try injectables with timed intercourse, and a trigger shot (Follitism, Lupron, etc).

  And from there is the slippery slope of, laproscopic exploratory surgery, IUI, and IVF, which HOPEFULLY we won’t need.

·        

Phew. If you read all of that you get a gold star!