Dear Dr Mitchell,
I am 29 years old and I've been with my boyfriend since I was 18. I have never been pregnant. I have all the features of PCOS and was diagnosed in December 2013. I did a hysterosalpingogram (HSG) test and the results were normal but the blood test showed that I'm not ovulating. I'm presently on Metformin and was on Diane 35 too. I am getting depressed as I would give anything to become pregnant. Can you please tell me what are my chances of getting pregnant and suggestions as to how to conceive? I am overweight and I'm trying to lose some weight. My being unable to get pregnant is destroying my relationship with my partner. I feel as though I'm going crazy. Please help me, I'm desperate. I'm not happy anymore as all I think about is having a baby.
Polycystic Ovarian Syndrome (PCOS) is a relatively common condition which is associated with excessive weight gain, irregular cycles, excessive male hormone production, and difficulty becoming pregnant.
The problem with polycystic ovarian disease is that you actually have eggs which develop within the ovaries but these eggs are not released. The ovaries becoming bulkier and then start providing extra male hormones which cause excessive hair growth on the face, chest and abdomen (hirsutism), hair loss in a male pattern type (temporal baldness), deepening of the voice and sometimes enlargement of the clitoris.
There is also an increased resistance to insulin and this results in an increased risk of developing diabetes.
The problems experienced with polycystic ovarian syndrome can be controlled and removed with proper management.
The first step is to lose weight and try to achieve your ideal weight for height. Losing weight can be difficult and sometimes it is best to get professional help from a dietician or nutritionist. You should reduce your intake of refined sugars and ice-cream, sweets, cakes and sweet drinks. Consumption of complex carbohydrates such as yam and banana is always better than refined flour and rice.
Reduction of intake of refined and fatty foods will also help to reduce your caloric intake. Eat brown instead of white bread and a regular exercise programme will also help to burn some calories. Exercising at least three to four days per week is ideal. Brisk walking is healthy.
The use of Diane 35 is a good choice to control cyst formation in the ovaries and reverse some of the changes caused by the increased production of testosterone (male hormone). Diane 35 or Cypress contains cyproterone acetate which is an antiandrogen. This counteracts the effect of testosterone. However, if pregnancy is desired, as in your case, it will prevent you from becoming pregnant since it is also a form of contraception. The use of Metformin is a good choice. This can be taken once or twice daily and helps to reverse some of the metabolic abnormalities caused by the polycystic ovaries.
This reduces weight gain and lowers the chance of becoming diabetic. It also helps to increase your chances of ovulation. The use of another drug called Clomiphene Citrate (Clomid) helps to induce ovulation. It is usually given on the third or fifth day of the menstrual period for a period of five days. You should then try to conceive regularly from day 15 to 21, counting from the first day of the menstrual period. A blood test which checks the progesterone level on day 21 will help to determine if you are ovulating on the Clomid and Metformin. If the progesterone level is low, then the Clomid dose can be increased gradually to achieve the desired progesterone level. Simple ovulation kits can be bought in the pharmacy and used to determine if ovulation has occurred by checking the urine.
In most cases the response to Clomid, Metformin and weight loss is good and conception occurs. In a few cases where no pregnancy occurs, invitro fertilisation (IVF) can be done with the use of more powerful drugs to induce ovulation. Your partner will also need to be evaluated to determine if he is the problem. A semen analysis can be easily done to determine if he is fertile.
You are young, so the outcome should be good. You should consult the Fertility Management Unit at the University of the West Indies headed by Professor Joseph Frederick if you are in Jamaica. You will be given guidance especially if you need IVF. You should also consult your gynaecologist in the meantime and take your spouse with you so he can be counselled and evaluated.
Lift your spirits, start a rigid exercise programme and a diet which will help you to lose weight.
Your chances of becoming pregnant will be very good. Start taking folic acid as part of your daily routine to reduce the risk of birth defects in the brain and spinal cord.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.