1st time PCOS, metformin, letrazol/clomid and iui/ivf help! advice?

[devilish_fetish]

I'm feeling very overwhelmed by all of this and need some help/advice. I was just diagnosed as having pcos by my re a few months ago... Friday DH and I went in for our "where are we now" checkup, since all of the testing is done. She put me on the extended release metformin, 750 mg first week, 1500 mg the second week+ and said she'll up it if necessary. I've been on the met since friday and its been rough! I'm afraid to be more than 10 steps from the toliet at any time! I've had a headache pretty much the entire time too, along with the bad nausea/diarrhea. Is this normal? She said the xr was supposed to be a little easier than regular met but that I could switch if I wanted to, but this is my first time taking met and i wouldn't know. Is the xr a little easier? Does it work just as well? Also, what else helps with pcos? I've got a mild case (I guess) in that my periods are pretty regular though I don't ovulate often, but I get bad, BAD cystic acne,(sometimes places I didn't even know one could GET acne!), migraines, hairs growing on my chin, chest, and stomach (but not a whole lot) and the hair on my head breaking off and falling out! I'd never heard of pcos before I was diagnosed, so I had never realized that all of these things were symptoms. Are there herbs and alternative remedies that help? One of the issues (besides the "string of pearls" in my ovaries) is that my LH and FSH ratio are flipped. Would anything besides the met help with this? I had read that losing weight helps, but is that only if you are overweight? I'm not overweight (but I'm on the heavy end of the "normal" spectrum) so would that even help me? I'm so confused because I'm not a "typical" case of pcos! Also, she put DH on conception xr (since he has low sperm count in addition to my pcos). Does anyone have any experience with this??? Then the rest she's left pretty much up to us. This is where I'm feeling overwhelmed too! We pre-emptively planned for an iui with letrazole in September, but have to confirm that's what we want to do. Our insurance pays for 3 cycles each of iui and ivf (one doesn't have to be done before the other) and the medication (in essence everything we'd need to do either). We don't know whether to do the iui or the ivf. My dh's sperm count is 7 or 8 million with 70% moving and 1 or 2% normal which we were told is low, but not low enough for her to say "only do ivf". August will make 15 months we've been trying to get pg, and I've charted everything but temps the entire time and used ovulation predictors for part of it (I'd always thought I was using them wrong when it never showed me ovulating...). I'm 22 and he's 28 and my egg quality is good. Both the iui and ivf seem equal (from our standpoint with our insurance and the fact that we're so borderline!) and yet so different! If we do the iui my doc says that we can do the letrazole OR clomid. I don't know much about either and haven't the faintest which would be better in our situation! This is all so overwhelming to me. I mean, I thank god we've got choices/flexibility and that our ins pays for it because I know a lot of ins doesn't (guilty pang ), but I feel so lost and confused by it all. It feels like the most important decision I'll make (right now) and I don't even know where to begin. Any help/advice?

[ChristyM26]

Well, first off, I understand how frustrated and confused you must be, since I was there once.

About the met, most people do say the xr is better. I take 1700mg of the regular and don't have much problem with it but can get some diarrhea if I eat something to fat or carb heavy. That might help you - cut back a little bit on the fat or carbs if you can and see if it gets any better. Otherwise, anything you might usually take can also help (whether herbal or otc meds).

I'm also just on the heavy side of normal. The met will eventually help you lose a little weight, though it won't be as much as you see with heavier women (obviously). That alone won't help your LH/FSH ratio. The met should help with that eventually though it can take a few months for that to happen.

I don't have much advice about your DH's sperm count cause that's one problem we don't have (fortunately), however I have some experience w/ the clomid/letrozole issue and the iui part. Our decision was to go with clomid and we discovered that my body reacts very, very strongly to it (in that we conceived quads, although two embryos died very early). Next time we'll try the letrozole first and see if I react not so strongly to that. That said, I'm apparently an anomaly in that area. Most people don't react like that to clomid.

I would start with the iui. Keep in mind this is based only on the research that I've done and not personal experience. Other people I've talked to said that the iui wasn't to bad (would they be triggering you or just monitoring to see when you o?) where the ivf was more invasive (egg retrival and all that).

If you have any other questions, feel free to pm me or ask here. HTH!

[devilish_fetish]

Thanks for the hug! I needed that. Sorry about your loss.

the met has gotten a little better. I can now be 20 feet from the bathroom instead of 10! : I guess every little bit helps tho. Thanks for the advice about the fat/carb thing! I'll try that and see if it helps more!

I feel like I've got a million and one questions! Are there any good books about ART that you'd reccommend? My RE said they'd be waiting until I o'd which is why we'd have to wait until september (that's the next af). Does triggering work better? Does clomid have a higher chance of multiples than letrazole? We'd like twins (at most)... just not first! :

I was reading that iui is a little less invasive, but didn't work as well as ivf. Is that true? Does ivf cause scarring on the uterus and would that interfere with being able to birth vaginally? I know it sounds like a stupid question, but I've never seen it mentioned. *blush* My doc explained the process of iui to me, but not ivf so I haven't the slightest clue what that's really like. Can someone who's gone through it tell me what its like? (Hormones, number of days it took, tips etc?) I think I'm leaning towards iui, but dh is leaning towards ivf (but that could just be him being impatient!) He also doesn't want to "waste" a cycle of iui if it doesn't work as well... My thoughts are that if the ivf works better, I'd rather "save" that for when I'm older and might "need it more", especially since we want to wait 4-5 years between our first and next babies... I don't think I'd want to throw in half the bag when a pinch would do... But I guess that's the difference between men and women. *sigh* part of the problem is we don't know the process of ivf to *really* know if that's something we can handle undertaking right now, kwim? Dh thinks so, but the thoughts going through my mind are "if the iui is less invasive and its already THIS rough, what's ivf going to be like?". Is leading up to it harder than iui, or just the procedure itself (the egg retrival etc)? Also, after reading the board a little more I saw that acupuncture before and after ivf helps it work better. Does the same go for iui? Has anyone done both iui and ivf that could sort of compare the experiences for me?

Also, I'm not currently taking any herbs and was wondering what would help. Is there any herbs to help me get a sticky baby once I do the ART? Any herbs I should be taking now to prepare? Any that would boost spermies in DH (especially girl spermies! : )? I just can't escape the feeling of being behind the 8-ball, like there's all of this stuff that I should have been doing to prepare but haven't been, kwim? Is that pretty "normal" (for a newbie) or is it just me?

[sselora]

I went to an acupuncturis/herbalist and I think it has been helping (I'll let you know in a couple of weeks
She prescribed to me an herb called Si Wu Tang Wan.
I went to the RE today and he says that my uterine lining looks awesome. So, can't be hurting at least! I highly recommend acupuncture/herbs to anyone!!

[ChristyM26]

Originally Posted by devilish_fetish

Does triggering work better? Does clomid have a higher chance of multiples than letrazole? We'd like twins (at most)... just not first! :

Triggering doesn't work any better, but can be a little more predictable, I think. Predictability can be really important when you're trying IUI. And yes, clomid does have a higher chance of multiples than the letrozole. Unfortunately, I don't know the percentages but I'll be on letrozole this time. My docs were very insistent that we try that first because of the lower risk of multiples (my OB almost fell over when she saw 4 gestational sacs at my first u/s).

I was reading that iui is a little less invasive, but didn't work as well as ivf. Is that true? Does ivf cause scarring on the uterus and would that interfere with being able to birth vaginally? I know it sounds like a stupid question, but I've never seen it mentioned. *blush*

I think that people say IUI doesn't work as well because conception is guaranteed with IVF (since it's all done in a lab) where as IUI is almost like regular conception, just giving the little swimmers an extra boost. They still have to do all the work though. I don't think IVF causes uternie scarring, and I have 2 friends who've gone through IVF and had vaginal births (a singleton and a set of twins) so that shouldn't be an issue. And nothing's a stupid question - that's how we get answers!

I don't have any herbal recs though. Nothing herbal has ever done much for me so far so I've kind of given up with them. If you're not already though, you should start taking prenatals and folic acid. Both of those will get your body in good shape (as far as vitamins go).

[devilish_fetish]

Originally Posted by ChristyM26

Triggering doesn't work any better, but can be a little more predictable, I think. Predictability can be really important when you're trying IUI. And yes, clomid does have a higher chance of multiples than the letrozole. Unfortunately, I don't know the percentages but I'll be on letrozole this time. My docs were very insistent that we try that first because of the lower risk of multiples (my OB almost fell over when she saw 4 gestational sacs at my first u/s).



I think that people say IUI doesn't work as well because conception is guaranteed with IVF (since it's all done in a lab) where as IUI is almost like regular conception, just giving the little swimmers an extra boost. They still have to do all the work though. I don't think IVF causes uternie scarring, and I have 2 friends who've gone through IVF and had vaginal births (a singleton and a set of twins) so that shouldn't be an issue. And nothing's a stupid question - that's how we get answers!

I don't have any herbal recs though. Nothing herbal has ever done much for me so far so I've kind of given up with them. If you're not already though, you should start taking prenatals and folic acid. Both of those will get your body in good shape (as far as vitamins go).

Ah, I see. I'd have to go in on cd 12 or 13 for mid-cycle labs (which seems a bit late to me..) But I guess if we do the iui and miss time O, maybe she'll trigger for the next one? *shrugs*

What brands do you recommend for the pre-natals and folic? I was just reminding dh today that we need to get folic acid (after seeing something about spina bifida). I had totally gapped on the pre-natals tho. Never hurts to be prepared... That's good that if we end up going with ivf there's not any type of scarring or anything to prevent us having a natural birth. I think we're going to try to find an acupuncturist to go to, regardless of if we do iui or ivf... At the least we figure it couldn't hurt, right?

I think dh's worry with the iui has to do with his low sperm count. I get the feeling that if we did iui and didn't concieve, he'd feel like it was his fault... I don't know that ivf would make him feel any better about that either tho... Conception would be guaranteed, but he might still feel responsible if we don't get a sticky baby...

Is it just me, or do you sometimes forget dp's feelings about not having conceived yet? I guess sometimes I just forget in the midst of BFNs and testing and more testing and AF and the general stress that goes along with IF that dh is going through it too... But i digress.

Sseloral: how long have you been going to the accupuncturist? How would I find one in my area? That's great that you're seeing results so far! Let me know how that continues to work for you! I'll have to google that herb... Would it be available outside of an accupuncturists office?

[sselora]

I'm in the middle of an IVF cycle right now and have gone to the acupuncturist twice so far and have 2 more visits scheduled this week and then hopefully she'll be available for the egg transfer later next week. I definitely felt a lot more blood flowing around my body or something after the first visit. My RE told me that there is a study out that followed 2 groups of women going through IVF, one that did acupuncture and one that didn't and that the one that did had higher percentage of bfps and also less m/cs. Can't remember who did the study. My RE says that somehow it gets more blood flowing to the uterus. So we'll see. About the herbs, my acupuncturist sold them to me directly out of her practice. The one's she sold me are made by Plum Flower Brand - I have absolutely no idea if that is a good brand or not. They are little pill like thingys. I found my acupuncturist by getting a list of them in my area from my RE. I found one that took my insurance so I went with her. SHe's really great too, so I guess I lucked out. Oh, one other thing. I wish I had done about 2 or 3 cycles of acupuncture and herbs before doing IVF - the acupuncturist I'm seeing says that she's had patients get pregnant just from those IVF prep months. If you don't get pregnant, then your body is in great shape to do IVF. GOOD LUCK!

[ChristyM26]

Originally Posted by devilish_fetish

What brands do you recommend for the pre-natals and folic? I was just reminding dh today that we need to get folic acid (after seeing something about spina bifida). I had totally gapped on the pre-natals tho. Never hurts to be prepared... That's good that if we end up going with ivf there's not any type of scarring or anything to prevent us having a natural birth. I think we're going to try to find an acupuncturist to go to, regardless of if we do iui or ivf... At the least we figure it couldn't hurt, right?

I'm cheap - I just use CVS brand of both. I've heard people talk about Rainbow (I think that's it) but I don't think it makes any difference. And you're right, the acupuncture can't hurt anything. It might help... I avoid needles, so I've not tried accupuncture but I also have a friend who was doing Mayan uterine massage. That sounds interesting to me.

Is it just me, or do you sometimes forget dp's feelings about not having conceived yet? I guess sometimes I just forget in the midst of BFNs and testing and more testing and AF and the general stress that goes along with IF that dh is going through it too... But i digress.

Well, originally, my DH wasn't to excited about the whole ttc thing. He kept saying he wasn't sure he wanted children. Right up until the moment I called to tell him I was in PTL. Losing the boys really made him realize how badly he did want kids, so now we're both just anxiously waiting for my body to get itself straightened out so we can try again. He has more patience than me though, so he's more likely to be the calm one through the BFN's (which I fervently hope for none of those and just a BFP). I think that it's men are just much less willing to admit when things are bothering them (at least mine is).

[Violet2]

I have PCOS too and I'm at the severe end of the spectrum. And PCOS is definitely a spectrum disorder.

First, keep in mind PCOS is more than just infertility. Women with PCOS are considered to be prediabetic and your risk of heart problems etc... is higher. So aside from ttc, try to find a regular endocrinologist who specializes in PCOS for long term care.

I'm not sure why you're considered atypical for PCOS. There are thin/normal weight women with PCOS. Some women menstruate and ovulate and still have PCOS. So, to me, you sound like a normal PCOSer.

The time released metformin is supposed to be easier on the body. If you have problems on the time released, you definitely don't want regular metformin. Ideally your body will adjust to the medication and you won't have problems in the future.

If you're looking for something else you can do to impact the PCOS a lower carb diet is helpful. The problem is, insulin is impaired or even functionally abnormal in PCOS and insulin interacts with your ovaries. So if the insulin isn't doing its job it can impair your ovarian function too. Lower carb diets limit the amount of insulin your body needs/produces/uses.

Also some women have great success with weight loss even if it's just 10 lbs. It didn't work for me, but others have had good experiences.

Lastly, the fact that you do ovulate sometimes on your own is fantastic and even with the male factor issues, I would think you have a very good chance. As for IUI vs. IVF...

The sperm issue may make IVF your only option, but I still say start with IUI because it's a cheap way to get some idea of how your body will respond to the medications. You are your own science experiment in infertility. Everything they learn with the IUI will help if you end up needing IVF.

Just be sure they monitor you very closely via ultrasound and bloodwork. Most High Order Multiples come from IUI cycles. You want your doc to check and be sure you don't have too many follicles cooking or else you may be having the next set of sextuplets. If they don't do routine monitoring, that's a sign you need a different doctor/clinic.

That being said, don't spend too much time on IUIs, particularly if the sperm counts don't improve. Me personally, I didn't have very good IUI cycles and I went on to IVF after 2 IUIs. You have to kind of see how things go when deciding how many IUIs to try.

If you decide to do IVF, be sure to talk to the doc about hyperstimulation and how they will monitor and care for you if you develop it. PCOSers tend to overrespond to the IVF meds resulting in OHSS, which can be a serious complication. So be sure your clinic and doctor are paying attention and are able to care for you because most ERs are not familiar with OHSS. You don't want to be sick and trying to explain IVF and PCOS and OHSS to clueless ER docs (I've run into ER docs who didn't know what an IUI was let alone PCOS or OHSS--not very many people do IVF/IUI so they aren't prepared for their complications in ERs).

I liked IVF. It was physically rigorous and expensive and not easy, but you get very exact results. The eggs either fertilize or they don't. You either have an embryo or you don't. They either transfer it or they don't. There's no ifs. The day they transfer the embryo, you're pregnant and just waiting to see if it sticks. So it's very yes or no. After all the ambiguity of IUIs I was just happy to get to the embryo stage, to know we could even get that far was a relief.

As for books to read...Eh. They're all pretty basic. The Idiot's Guide to Infertility was a decent primer, but basic. I think you might get more out of joining Resolve and getting their newsletter than a book. You'll also find a local support group helpful (you learn about the docs and different protocols in your area--plus lots of advice from those who've gone through it.)

Hope this helps,

V