Is this treatment too aggressive?

[songbird45]

This is longer than I intended, sorry. But I figured that to get the best advice I should include lots of detail.

So I'm not even really sure what to think here. The OB showed me the bloodwork and ultrasound results and I agree with her PCOS diagnosis. There's the long irregular cycles, the cysts, the LH-FSH ratio (15 and 7 respectively), acne, and facial hair. I don't have irregular weight gain patterns, nor am I overweight.

She wants to put me on progesterone to force withdrawal bleeding, and then she suggested CLOMID! Not metformin, which is what I expected. She said the latest research showed that if you want to ovulate, you should just go straight for the Clomid and the met doesn't provide much additional benefit. I asked about more holistic/natural treatment, and she said to get some Omega 3 supplements and eat more leafy greens (folic acid) and replace sugar for more complex carbs (whole grains, multi grains). She said that we would try the holistic approach for 3 months, and if that didn't work, move to the Clomid. She said that for overweight people she recommends cutting carbs but since I'm not overweight she can't recommend that for me.

So... does anyone have opinions about if what she's suggesting seems reasonable? And as far as the holistic approach, how can I even out the LH-FSH ratio?

[LisaG]

Hi songbird,

One of the questions I have is your age? I would tend to go for more aggressive treatments if age were a factor (35+).

I now there is a thread or was a thread specific to PCOS and they might have some suggestions/insights for you.

You might also want to look into purchasing one of the blood sugar monitors so you can check your blood sugar at home and see how it is being impacted by your diet. There is a good book out there on fertility and insulin resistance - I apologize I can't find the title of it, but maybe someone else knows? It might address the LH-FSH ratio.

Other questions I have for you - do you eat a carb dominant diet? What's your protein intake like? Are you balancing your carbs/protein/fat?

I'm a little puzzled about her not wanting to put you on metformin - but I'm definitely not up on the latest research. It would seem that if she does want to use clomid to boost ovulation, then regulating your blood sugar would also be important not just for conception but for a healthy pregnancy. Another question I thought of - is she an ob/gyn or an reproductive endocrinologist?

Good luck - I'm sure others will have words of wisdom to add.

[songbird45]

Originally Posted by LisaG

Hi songbird,

One of the questions I have is your age? I would tend to go for more aggressive treatments if age were a factor (35+).

Nope, I'm 28.

Other questions I have for you - do you eat a carb dominant diet? What's your protein intake like? Are you balancing your carbs/protein/fat?

I'm a little puzzled about her not wanting to put you on metformin - but I'm definitely not up on the latest research. It would seem that if she does want to use clomid to boost ovulation, then regulating your blood sugar would also be important not just for conception but for a healthy pregnancy. Another question I thought of - is she an ob/gyn or an reproductive endocrinologist?

She said she didn't want me to cut carbs because I was so thin; she didn't think it would be a good idea to cut anything from my diet. I'm vegetarian which makes cutting carbs and getting enough protein a challenge. I do try, though. She's an ob/gyn. I guess maybe she doesn't think that blood sugar is an issue, since I'm thin? I have a family history of diabetes but my blood sugar levels have always been normal (up till now).

I dunno, on one hand her plan seems sensible. I have no symptoms of problems with my metabolism, and I have a few symptoms of hormonal imbalance (facial hair, acne, lack of periods). So it seems to make sense to treat the hormone part of it. But on the other hand I'm just a little shocked about jumping straight into Clomid.

Thanks for replying! Any other thoughts out there?

[allisonrose]

Many doctors feel that ovulation should take place early in the cycle and will prescribe clomid to achieve that. I've heard that with PCOS, even if you do ovulate, you might not release a high quality egg. I believe there's some evidence that Clomid can improve the quality of your egg.

Depending on how long you've been TTC, you might consider seeking out an RE who specializes in PCOS.

[cristeen]

I would look for a second opinion, preferably from someone with experience treating women with PCOS. I would also closely evaluate your diet. How much soy do you eat? For women with PCOS, soy can have a deleterious effect on already imbalanced hormones.

There is a PCOS Tribe in the FYT section, there is a lot of great information on there, and lots of mamas who have gone through (or are going through) this.

Clomid by itself is not going to resolve the hormone imbalance. It will only treat one of many symptoms (annovulation). Fact is that every body is different. Some women's cycles regulate on Metformin alone. Some need Met plus Clomid to ovulate, some need both plus an hCG trigger (that was me). Forcing ovulation without treating any of the underlying hormone imbalances can lead to miscarriage.

Another option is accupuncture and/or Chinese medicine. Many women with PCOS swear by it. Of course then there is also changing your diet. I would seriously do your research and decide which steps you'd like to take and in what order before jumping straight to Clomid.

[anonymousk]

I am in a similar situation - 27, thin, reverse in my LH/FSH, acne, facial hair, 16 months of infertility. I started with Metformin and we are on our fifth cycle of clomid so far. I think the question of whether or not the course of treatment is too aggressive is really a matter of perspective. We saw an RE before we started this course of treatment and felt that his treatment plan - straight to injectibles without much testing - was too aggressive for us. We did three months of acupuncture before seeing either of them, and while I did see changes in my cycle it really wasn't working for me. We've had other meds added to the regimen over the months - dexamethasone, amoxicillin, prometrium, and are starting to see the hormones coming in to line. At this point, knowing that in similar situations clomid has a pregnancy rate of about 30-40%, I am questioning whether or not we should have taken a more aggressive approach... but you have to make the best decisions that you can with the information you have on hand.

Best of luck to you. I hope you find some answers soon.

[kristenok18]

If you decide to proceed with the clomid, INSIST on ultrasound monitoring during each cycle. I have pcos and was put on clomid with no monitoring. During the 3rd cycle, in which we thought we'd be doing our IUI, we finally had an u/s. We discovered the the clomid caused my ovaries to become encrusted with tiny cyst caused by underdeveloped follicles. I had to take 6-7 months off before I even ovulated again. I started metformin, even though I am *not* insulin resistant, and that also helped to regulate my cycles and clear the cysts. I started femara instead of clomid, and conceived on the first cycle.

[thismama]

I am not up on the super-up-to-date, but that doesn't sound entirely right to me. I was annovulatory, took Met alone, and got pg immediately. All evidence I have read is that Met is extremely helpful for PCOS, and that Met + Clomid is much more effective than Clomid alone.

I would seek out more opinions, personally. Check out the discussion boards at www.soulcysters.net, coz damn those women know everything.

On the blood levels, my blood sugar was always within normal range. My *insulin* was totally out of whack. Blood sugar won't tell you anything except you don't have diabetes. What is useful are fasting insulin/blood sugar ratios.

Good luck! Go ask at soulcysters. And from what I have read in the TTC forum there, most women are on Met or a Met/Clomid combo. I wouldn't worry so much that the Clomid is too aggressive, but I would worry that it may not be effective without Met too.

Good luck!!