Dear Dr Mitchell,
I have been diagnosed with PCOS since 2010 and have been trying to get pregnant without success for the past year and a half. Although I have this condition, I menstruate every month and I can time it like clockwork. I am overweight but my weight is stable as I have had the same weight for the past six years, give or take a few pounds. Is it possible that I might be menstruating but not ovulating? Or could there be other underlying problems?
Polycystic ovarian disease is a fairly common condition which is associated with excessive weight gain, irregular menstruation, difficulty becoming pregnant and excess production of excessive male hormones.
The first thing that you need to do is to lose weight. The fact that your weight has been stable for the past six years is not reassuring. You should try to at least achieve your ideal weight for height. This can be done by regular exercise at least three times per week and an appropriate diet that is low in fats and refined sugars. Once you lose the weight, you will have regular predictable cycles and your frequency of ovulation will be increased and your chance of becoming pregnant will definitely improve.
The use of Metformin tablets to help to improve your fertility is advised. This can work well on its own or with the use of Clomid (Clomiphene Citrate). The Metformin can sometimes cause nausea and diarrhoea, but you should try to be compliant with it since these symptoms are short-lived.
If you still do not conceive despite these measures, then surgery can be done to drain the ovarian cysts and make the ovaries smaller. This can be done by laparatomy or laparoscopy. The outcome with this is good but usually only done if medical treatment fails.
It is important to do an X-ray of the fallopian tubes and uterus (hysterosalpingogram) to ensure that the tubes are not blocked and the uterus is normal. Your partner should also do a semen analysis to ensure that he is not the cause of your inability to conceive. If conception still does not take place then invitro fertilisation can be done with very good outcome. The Hugh Wynter Fertility Unit at the University of the West Indies offers this procedure and the outcome is extremely good.
Consult your gynaecologist or general doctor who will advise you further. You should take folic acid daily since you are trying to conceive since this will reduce your risk of having a baby with defects in the brain and spinal cord. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to email@example.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.