Posted by: Clare | 2009/01/10

Newly diagnososed with 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 ImageGynaeDoc

1. It is difficult to give a figure. You will have to try it and see.
2. Your miscarriage rate should not be significantly higher.
3. 3-4
4. It is the glucose insulin ratio that is important. Yours is probably borderline. If so, this will increase the risk of gestational diabetes
5.Weight loss will help. Your BMI (weight/ height squared) should be less than 30
6. A low GI diet would be the one to follow.
7. Insulin resistance is diagnosed with a glucose insulin ratio of < 0.5

Best wishes

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Our users say:
Posted by: LL | 2009/01/12

Hi there! You can also post your question on theinfertility supposrt as the ladies there will be able to answer quite well too. I' ll try answer a few:

4. No you dont have a greater chance for diabetes if you look after your levels. Mine was 27 when i got diagnosed at age 21. Im not 26 and dont dont any meds for it because i am looking after it. (ive had pcos from the beginning wehich would be age 12)
5. They weight loss apparently helps, lowers the insulin resistance.
6. Reccommended eating plan is a low GI one with exercise.
7. Im not a doctor but i doubt you are already insulin resistant, but may possible become so start doing something about it now while your levels are still in the normal range. Doubt you need to taked meds already.

Just get on a low gi eating plan, make it your lifestyle and your insulin will be kept normal.

Good luck with it all!

Reply to LL

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