PCOS Questions

[karlatta]

Anyone have a lot of PCOS knowledge?

I was diagnosed in August or September 2004. I was put on 1500mg Metformin. Every cycle that I've had since then has been medicated in some way - BCP, Letrozole, or something. We are TTC.

My DH and I are looking for some TTC treatments that may work and that will be more "natural" than what the RE is suggesting. (He's suggesting injectibles and an IUI.) We've not let my body do it's own thing in several months, so we thought it might be nice to try for a while and not be so invasive. We were thinking things like Clomid (especially if it wouldn't require a trigger and costly ultrasounds), just taking hormones, trying just the Metformin, etc.

What I'd like to know is what kind of treatments you've done for your PCOS. All we've really done is the Letrozole with an hCG trigger, which does make me ovulate. We're willing to do things that are less likely to result in a pregnancy for a little while - we're just tired of the stress of all of the doctor's appointments and what-not.

Thanks!

[jennylou]

Hi Karla

I have PCOS. When I was seeing my old OB/GYN she would only give me Metformin and progesterone to bring on AF. That got old pretty quick, so I went to the RE. The RE (after a SA on DH) prescribed 50 mg of clomid and 1500 mg of Glucaphage (Metformin). I would have had one ultrasound per cycle, at the beginning to check for cysts. I also had blood work on 7 dpo. 50 mg worked on our first try. My old OB/GYN left the office and I found a great new one. When we start trying again, I will start clomid/Metformin treatments with her. She is the only one in the practice that prescribes it. She does require the CD 3 ultrasound as well.

Some docs won't require any u/s at all, but honestly, you really need that first one to make sure you don't have any cysts. The bloodwork on 7 dpo will tell you if you've O'd, as will charting. I never had a trigger, so maybe you could ask the RE if you could opt out of the trigger? That would cut out those middle of the cycle u/s.

Good luck...you may want to join us (if you haven't found your way there yet) in the SAI thread under Groups.

[karlatta]

Thanks, Jenny. I was part of SAI at the other place and I joined up here this afternoon.

Question - when you did the Clomid, how did you know when you O'ed? I know I O'ed on Letrozole (which is a lot like Clomid), but I always did an hCG trigger, and the ovulation never showed up in my charts with a temp shift or anything. Did charting work for you?

Also, I don't mind the CD3 u/s - my insurance pays for those. :D It's the follicle scans at $250 a pop that I'm trying to avoid. :)

[amygrrl]

hello miss karla... when i first began TTC, my dr, dr. cataldo, was doing a study at stanford on PCOS. he put me on a cocktail of metformin with avandia. from what he told me, it was VERY successful at regulating your cycle. each is an insulin sensitizing drug, but they work in 2 very different ways apparently. also, it takes a few months for the metformin to really get things going in your system while the avandia acts pretty immediately. taking those 2 drugs and 100 mg of clomid i ovulated multiple eggs per cycle (2 or 3 each time) and i have a pretty severe case of PCOS. i just didn't get preggo and they were never sure why. i was also on these 2 drugs during stimulation for the IVF and all my embries came out as grade A. on the other hand, my sister also has PCOS and has only taken the met and always sporadically and when she did IVF she had fewer embries than me and they were all poor quality. i personally think that the difference is my long term metformin use (since i was 28) combined with the avandia as i have noticed that my cycles are MUCH more regular on the drug combination.

dr. cataldo told me that the various stim drugs don't help PCOS patients impove their egg quality but that the insulin drugs did. his study is on the endocrine today site, but i can't get to it b/c it requires a membership.

oh... i just remembered.... way back in 1997 or 1998 when i was first diagnosed with PCOS, it was an endocrinologist in Houston who discovered my problem. she was GREAT and very involved and seemed to be on the leading edge of research for the disorder as she put me on the metformin way back then and i remember other dr's i saw thought she was crazy... anyway, i can try to find her info in my medical records if you like and forward it over to you. her office was off of I-10 between 610 and the beltway on the west side of town maybe 1/2 hour from stafford.

[amygrrl]

ok... just in case you want it, her name is Lorie M. Shapiro, M.D. and she is with Endocrinology Assoc. of Houston which is at I-10 and Dairy Ashford. maybe try going to see her and see if she recommends anything.

[jennylou]

Question - when you did the Clomid, how did you know when you O'ed? I know I O'ed on Letrozole (which is a lot like Clomid), but I always did an hCG trigger, and the ovulation never showed up in my charts with a temp shift or anything. Did charting work for you?

My REs office asked me to use OPKs as well as chart. Once I got a positive OPK, I set up my 7 dpo bloodwork to confirm O. But, the O did show on my chart, though, it's not the prettiest chart...the temp shift wasn't drastic like some charts I've seen.

[karlatta]

Amy - Thank you. I see Dr. Michael Allon, who I love, but I'm not sure that we're going to be able to come to an agreement on my treatment. Even though his specialty is PCOS. Dr. Shapiro wouldn't be any further from my house than his office is!

Jenny - You know what? I remember now my RE telling me that I should use OPK's. But I'm a cheapskate and didn't want to. Heh. Maybe I'll get on that. Thanks!

[angelgirl8]

karla...it's not clear whether i was ever officially diagnosed with PCOS, but i have heard really good things about acupuncture as a treatment for PCOS if you want to look into that either by itself or in conjunction with the met and/or clomid.

[QPDoll]

My experience is very similar to Jenny's.

I was put on 1000mgs/day Metformin for 4 months. The 5th month I upped my dosage to 2000mgs/day and added in 50mgs of Clomid. Pregnant on the first try of clomid.

I was charting every month and also used OPKs the clomid month.

I had also been seeing a chiropractor. My lower back has always been messed up, and that part of the back is also connected to reproductive organs. He knew of us TTC, so he concentrated on that part of my back.

[Heather719]

Hi karlatta-

I was dx with PCOS in Jan 2004. I was very lucky to have a wonderful ob/gyn who was very pro-active with my treatement. During each of my clomid cycles I had a CD12 u/s and a 7DPO progestone test. I used OPK during each of those cycles as well to help me pin-point my acutal O-date (typically for me, I O'd between CD15 and CD17). I have never charted.

We started me out at 50 mg of Clomid- and that didn't work. The next cycle I tried 100 mg of Clomid and got pregnant! :) Unfortunately, I m/c within a couple of weeks. We took a 3 month break, during which I started taking 1500 mg of Metformin (which I still take daily). After our break, we started again with 100 mg of Clomid. That cycle was a bust- I didn't ovulate at all. We then jumped up to 150 mg of Clomid - I O'd on during each cycle with that dosage and finally got pregnant my 3rd cycle on it. Again- that ended with a miscarriage. I was given a battery of tests to figure out why I kept miscarrying and we determined that I had a blood clotting problem. At this point, my ob/gyn did all she could for me and I started seeing my RE.

The RE recommended that I use 150 mg of Clomid again with an HCG trigger and IUI for my first cycle with him. I O'd, but didn't get pregnant. So this cycle we used Injectables (Gonal-F and Lupron) with an HCG trigger and IUI. I'm currently in the 2WW. :)

The only "alternative" thing I've done is acupuncture (in conjunction with Western meds). I love acpuncture and have had great success with it- I have O'd each and every cycle I have done acupuncture during. My RE actually highly recommends acupuncture in conjunction with regular meds.

Best of luck to you!