Posted by: Clare | 2009-01-10

Newly diagnosed PCOS

Good morning Doctor,

I was on Depo for +- 5.5 years. I stopped Depo in April 2007. Ever since I have had irregular periods. I had an external ultrasound and blood tests done in April 2007 and it showed the endometrial lining was normal, and no cysts were obvious in either ovary. The uterus was also normal. My blood test showed my progesterone level was 2 which means I was not ovulating.

I did not use any birth control again, and in July 2008 I saw a gynae for a check up and he did an internal ultrasound and blood tests. My progesterone level came back at 1 and my ultrasound was normal. I was put on 100mg of fertomid but only took it for one cycle.

I saw my gynae on Monday this week, now he has advised that I have pcos. My insulin (fasting) came back as 10, I was told that normal is between 0 and 10. He has given me a course of nordette, so that we can get my cycle on track and then before I start the red pills I need to see him again for a prescription of clomid. He has advised that I don’ t have most of the typical symptoms of pcos, i.e. excessive weight gain, acne, excessive facial hair etc.

My husband has been sent for a sperm analysis, his tests are pending.

My questions are as follows:

1. What are my chances of falling pregnant on clomid with pcos?
2. If successful what are my chances of miscarriage?
3. How many cycles of clomid is the standard before having a successful pregnancy? I have heard 4 –  6?
4. With an insulin level of 10, do I stand a greater chance of being diagnosed with gestational diabetes?
5. Will weight loss assist me in falling pregnant  I weigh 95kg, how much weight should I lose to increase chances?
6. Can you recommend a eating plan, which will help me to bring down insulin levels?
7. In your opinion with a insulin level of 10, am I insulin resistant? And if so should I be taking glucophage or metmorphine?

Thank you very much for addressing these questions.

Kind regards

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Our expert says:
Expert ImageFertility expert

Dear Clare

Firstly, I would like to complement you for the excellent synopsis of your problem and for the very pertinent questions that you have put forward. In the first instances I am not absolutely convinced that the diagnosis of PCOS is certain. The elevated insulin level is on the upper limit of normal and therefore is not diagnostic of insulin resistance or of PCOS. Obviously there is a strong family history of Type 2 diabetes and this might suggest a predisposition in developing not only insulin resistance but also diabetes at a later stage, gestational or otherwise. There is a strong body of literature evidence, which suggest that simply having a higher than normal BMI (body mass index) will result in not only insulin resistance metabolic syndrome changes but also cause ovulatory dysfunction and menstrual irregularity with features not dissimilar to PCOS. There should also be very clear diagnostic evidence on internal scan of PCOS. My advice would be to attempt weight loss by means of carbohydrate control and a low glycaemic index diet (typically meant for diabetic patients). You should aim for a BMI of below 25% and more closer to 20-23% for the purposes of ovulation. The use of Clomid in this situation may be of value to increase your chances of ovulation but there is also suggestion that Clomid may predispose to a slightly increase risk of miscarriages but I would not let that be a major deterrent to it’s use. I do not advise the continue use of Clomid from cycle to cycle but instead it is best to use Clomid a maximum of 2 consecutive cycles and then interrupting it for at least 2 to 3 months before starting again.

Answered by: Dr. M. I. Cassim

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Our users say:
Posted by: Clare | 2009-01-14

Thank you so much for answering my questions. My husbands sperm analysis came back normal and i also forgot to mention that there is a history of diabetics on both sides of my family (both grandmothers) I also just want to mention that on the most recent internal ultrasound you could clearly see little " sacs"  in the ovaries. Once my gynae received my blood/insulin tests he said that he does not rule out polysycis ovarian syndrome even though i do not appear to have most of the symptoms other than being a little overweight, ie i do not have excessive facial hair, loss of hair, and acne which according to him are all indicators of pcos. I am currently on the pill " Nordette"  for 24 days and then i am seeing him again for further instructions. He had discussed putting me on some clomid, and i remember him saying that i will need to use more than one cycle. I have cut out all starch and eat mainly fruit during the day with water. i have also purchased an orbitrek and will try my best to exercise 30mins a day along with a 1km walk. I am hoping that these will all assist me in loosing weight and keeping any insulin " diabetic"  problems at bay. Thanking you kindly

Reply to Clare
Posted by: nao | 2009-01-14

I would like to receive answers to the above questions because I seem to be having almost the same problem with clare, although am not sure I understand some of the medical terms used (like PCOS, DEPO). I will later send in my story so that you then address my problem specifically.

Thank you in advance.

Reply to nao
Posted by: Clare | 2009-01-10

I forgot to mention neither my husband nor i spoke or drink. Thanks Clare

Reply to Clare

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