Dear Dr Mitchell,

I’m reaching out to you about a fertility problem that I am currently experiencing. First let me say you are doing a good job providing important information and proper advice to women who are having fertility problems.

I was diagnosed with PCOS a year ago. I have been trying to conceive for almost a year and a half. Sad to say I have had no positive results so far. I am 23.

I had irregular periods or none at all for an entire year. When I first started seeking help from my doctor I was placed on Provera to help bring back my periods. Then I was told to start taking Metformin. After seeing my period and taking the Metformin for a few months, nothing happened.

I was then placed on Diane 35 to help regulate my periods. It did help with my period but then the bleeding wouldn’t stop. It would happen for a whole month. I couldn’t take it anymore so I got an injection of Depo Provera to stop the bleeding.

I need assistance with fertility treatment. Do you have any recommendations?

Polycystic Ovarian Syndrome (PCOS) is a relatively common condition which causes irregular menstrual periods, excessive weight gain and excessive production of the male hormone testosterone. Women with this condition have excessive hair growth on the face, chest and abdomen in a male pattern type of hair growth.There may also be deepening of the voice and enlargement of the clitoris in severe cases. The condition is also associated with difficulty becoming pregnant because of the failure to release an egg every month. The menstrual period may disappear for several months or may be of a long duration with heavy blood loss when it comes.The mainstay of managing PCOS is to lose weight and achieve your ideal weight for height. This can be done by a rigid diet that significantly reduces the intake of refined sugars such as cakes, sweets, chocolates, fried and fatty foods. The intake of calories should be reduced significantly and frequent small meals, which should include three main meals and two snacks, should be consumed. It is always a good idea to get the help of a dietician who will guide you with your portions and the appropriate foods. Women with PCOS have an increased risk of developing diabetes mellitus and weight loss will definitely help in reducing this risk. It is important especially if a pregnancy is being planned, since pregnancy also increases the risk of developing diabetes mellitus. Weight loss and blood sugar control before becoming pregnant are extremely important. A regular exercise programme will go a long way in helping to burn some calories and cause weight loss. Exercising at least three times per week is a good habit. Regular walking is also a good and inexpensive practice which will help to burn some calories. Enrolling in a gym with supervised exercises will definitely help if this is affordable.The use of Metformin will definitely help to reverse some of the changes causes by PCOS. Metformin can cause nausea and diarrhoea in some cases, but with continued usage these symptoms will disappear. The extended release preparations tend to be associated with fewer symptoms. Diane 35 contains cyproterone acetate which is an anti-androgen and this helps to reverse some of the androgenic effects such as the hair growth on the face, chest and abdomen. It also reduces cyst formation in the ovaries and helps to establish regular cycles. This has to be discontinued and clomiphene citrate (Clomid) used in addition to the usage of Metformin to induce ovulation if pregnancy is desired.Diane 35 and Depo Provera will definitely prevent pregnancy since they are both contraceptive methods. Depo Provera is also associated with excessive weight gain and is not a good choice for the control of abnormal uterine bleeding in women with polycystic ovaries, especially if you are overweight and wish to become pregnant. It can also be associated with irregular uterine bleeding in the first year of usage. Treating PCOS requires patience and discipline. You have to be prepared to stay on the medication and stick with the weight loss programme. The outcome is usually very good, but if the use of Clomid does not induce ovulation, more powerful drugs can be used to achieve ovulation and help you to get pregnant. Invitro fertilisation is an option in some women who do not respond to the treatment with Clomid and Metformin. You are only 23 years old and you should do very well since your egg quality should be very good. Consult your gynaecologist who will advise you further and put you on a regimen which will work if you will be patient and stick with the programme. Best wishes!

Polycystic Ovarian Syndrome (PCOS) is a relatively common condition which causes irregular menstrual periods, excessive weight gain and excessive production of the male hormone testosterone. Women with this condition have excessive hair growth on the face, chest and abdomen in a male pattern type of hair growth.

There may also be deepening of the voice and enlargement of the clitoris in severe cases. The condition is also associated with difficulty becoming pregnant because of the failure to release an egg every month. The menstrual period may disappear for several months or may be of a long duration with heavy blood loss when it comes.

The mainstay of managing PCOS is to lose weight and achieve your ideal weight for height. This can be done by a rigid diet that significantly reduces the intake of refined sugars such as cakes, sweets, chocolates, fried and fatty foods. The intake of calories should be reduced significantly and frequent small meals, which should include three main meals and two snacks, should be consumed. It is always a good idea to get the help of a dietician who will guide you with your portions and the appropriate foods.

Women with PCOS have an increased risk of developing diabetes mellitus and weight loss will definitely help in reducing this risk. It is important especially if a pregnancy is being planned, since pregnancy also increases the risk of developing diabetes mellitus. Weight loss and blood sugar control before becoming pregnant are extremely important.

A regular exercise programme will go a long way in helping to burn some calories and cause weight loss. Exercising at least three times per week is a good habit. Regular walking is also a good and inexpensive practice which will help to burn some calories. Enrolling in a gym with supervised exercises will definitely help if this is affordable.

The use of Metformin will definitely help to reverse some of the changes causes by PCOS. Metformin can cause nausea and diarrhoea in some cases, but with continued usage these symptoms will disappear. The extended release preparations tend to be associated with fewer symptoms.

Diane 35 contains cyproterone acetate which is an anti-androgen and this helps to reverse some of the androgenic effects such as the hair growth on the face, chest and abdomen. It also reduces cyst formation in the ovaries and helps to establish regular cycles. This has to be discontinued and clomiphene citrate (Clomid) used in addition to the usage of Metformin to induce ovulation if pregnancy is desired.

Diane 35 and Depo Provera will definitely prevent pregnancy since they are both contraceptive methods. Depo Provera is also associated with excessive weight gain and is not a good choice for the control of abnormal uterine bleeding in women with polycystic ovaries, especially if you are overweight and wish to become pregnant. It can also be associated with irregular uterine bleeding in the first year of usage.

Treating PCOS requires patience and discipline. You have to be prepared to stay on the medication and stick with the weight loss programme. The outcome is usually very good, but if the use of Clomid does not induce ovulation, more powerful drugs can be used to achieve ovulation and help you to get pregnant.

Invitro fertilisation is an option in some women who do not respond to the treatment with Clomid and Metformin. You are only 23 years old and you should do very well since your egg quality should be very good.

Consult your gynaecologist who will advise you further and put you on a regimen which will work if you will be patient and stick with the programme. Best wishes!

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.

DISCLAIMER

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.