Our expert says:
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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