Problems conceiving
Dear Dr Mitchell,
I am 31 years old and having problems conceiving. The last ultrasound I had showed that I have PCOS. How can I get pregnant?
Polycystic ovarian syndrome (PCOS) is a fairly common problem that is seen in women who are trying to become pregnant. It is a condition where the woman produces eggs but they are not released from the ovaries in a regular monthly cycle. These underdeveloped eggs stay within the ovaries and form multiple small cysts. The ovaries become bigger over time and then produce an excess amount of testosterone (male hormones). The baseline production of the hormone progesterone also decreases significantly when ovulation does not take place frequently.
The common presenting problems are excessive weight gain, irregular menstrual periods, and excessive hair growth on the face, chest and abdomen in a male pattern type. There is also an associated problem with acne on the face, back and chest in some women. There is also an increased risk for developing diabetes mellitus because women who have polycystic ovaries tend to have insulin resistance and have higher blood sugar levels than usual.
The simple way forward is to try and control the excessive weight gain and achieve your ideal weight for height. This will help to control a lot of the symptoms associated with polycystic ovaries, reduce the risk of diabetes mellitus, and improve fertility.
The use of the drug Metformin can also help to reverse some of the problems and improve fertility in women trying to establish a regular monthly cycle. The use of a low dose oral contraceptive pill can help to suppress cyst formation in the ovaries, reduce excessive thickening of the lining of the uterus, and establish regular monthly periods. Choosing a contraceptive pill that has cyproterone acetate which contracts the effects of the excessive male hormone testosterone can control the excessive hair growth and acne problems that are frequently seen in women with polycystic ovaries. Preparations such as Diane-35 and Mistral are good options.
In women trying to become pregnant the use of clomiphene citrate (Clomid) and Metformin will definitely help to improve the chance of becoming pregnant. It is important to have a close follow-up with your doctor and ensure that you’re on the correct dose of Clomid that will achieve ovulation. Checking the level of progesterone in the blood 21 days counting from the first day of the menstrual cycle will definitely help in this regard. If there is resistance to Clomid then there are other powerful drugs that help to induce ovulation. It is also important that your partner does a semen analysis to ensure that he has no fertility issues.
Consult your doctor who will advise you further and decide which treatment option is best suited for you.
Best regards.
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 Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. 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.
