Posted by: Caroline | 2007/04/16

PCOS / pregnancy

Hi Doc,
I am 37 and have been ttcing for 4 years. Went to a RE in the beginning of last year and was diagnosed with PCOS. I dont have the polycistic ovaries of the physical atributes like facial hair etc but i have the high LH levels which was discovered after lots of blood tests over 6 months. My cycle was always irregular. I was put on 850mg Metphormin daily in November. The first cycle was 46 dyas , second 34 and the next two 28 HOWEVER the Jan 28 day cyle period was only spotting - light spotting no red. Then 28 days later my period started again but only spotting again so i went back to the RE (cos i was on a four month rest while taking metphormin) so he could check (it was day 10) and there was twin gestational sacs! He immediately ordered hcg test and unfortunately the hcg level was 2. He gave me progesterone and ten days later i started bleeding heavily - really heavy with heavey cramps that i couldnt go to work even. Heavy as in changing sanitary every hour (sorry for that). This was i presume a bloated ovum? Does that mean i have a better chance of falling pregnant now or is that just myth? The gestational sacs when he saw them on the screen of the vaginal scan were 5 weeks - what in your opinion happened? Sorry for the essay.

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Our expert says:
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Dear Caroline

In the first instance the diagnosis of ovulatory dysfunction is extremely likely, but the underlying cause is yet to be established. It is occasionally possible to diagnose PCOS without any physical attributes, but purely on the basis of ultrasound examination. I find it difficult to correlate a negative HCG blood test with the ultrasound findings of twin gestational sacs. As a general rule if a single gestational sac is seen even in an impeding miscarriage situation one would still expect an HCG level in excess of 3000 and therefore I can only presume that what was seen on ultrasound was a pseudo sac. Such a pseudo sac may be due to fluid accumulating in the endometrium or the presence of blood clots some of which may have haemolysed within the endometrium (uterine cavity). This will correlate strongly with the increased heavy bleeding that followed and it is often the shedding of a decidual cast. I would therefore consider a review of the entire process and diagnosis before embarking on further treatment.

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