PCOS: but I think I am ovulating?

[minciepie]

Hi everyone

So, I've just been diagnosed (by scan) with PCOS . I haven't seen the GP to discuss this yet as I have to wait to have blood tests too. We've been ttc for 6 months.

The thing is, I am getting periods (long cycles 32-40 days but fairly regular) and I use OPKs and get a positive result every month, always 14 days before AF. So that seems to say I am ovulating? Or is it possible to get a +ve OPK without ovulating?

I guess I am wondering what treatment there might be for PCOS that would help me get pg. Clomid seems to be the usual, but if I am already ovulating then Clomid won't help I presume ...?

Any thoughts or experience would be very much appreciated... Thanks.

I also have polycystic ovary syndrome, and i saw a gynaecologist, and was told they wanted to put a camera in so they could see exactly what was going on. I was also on metformin, which did help. Luckily, despite having pcos, i fell pregnant with my baby son completely naturally, so was very lucky. Just cos you have pcos, it doesnt mean you wont get pregnant, it just sometimes takes a little longer, my first pregnancy took 2 years, as did my second and my third (where my ovaries were worst) took almost a year to the day since we miscarried. Try not to lose hope, or pin your hopes too much. Best thing to do is relax, when i knew that i was going to get help i relaxed and fell pregnant straight away.

Good luck. xxx

Thanks Ellen, nice to hear positive stories. I'm a bit confused about metformin - is it just for weight loss or does it help with fertility in other ways too?

I am trying to stay relaxed about it and not stress - it's just hard to be patient when I seem to be surrounded by friends who get pregnant in the blink of an eye...

Be aware of the difference between polycistic ovaries and the syndrome. The 2 are different and you can have polycistic ovaries but not the syndrome. If you have the syndrome (difficulty losing weight, acne, problematic hair growth etc) then it makes things trickier, I believe. However, you can have the polycistic ovaries but have no problems conceiving. This is what my doctor told me. Good luck and positive thoughts!

Thanks - I don't have much information at the moment, the GP's receptionist just told me that the scan results said PCOS. I do have acne (have had for years), but I don't have weight or hair issues.

I don't know much about PCOS, but as I understand it, people with PCOS tend to ovulate erratically?? But you have nice regular cycles which is positive. (It is possible to get a +OPK without ovulating, though - have you considered basal temping?)

My cycles are a bit bizarre - basically since July they've gone 32, 34, 36, 40 days... so they seem to be getting longer each month! but that is still fairly regular compared with what I've read about PCOS.

Yes I've considered temping but must admit I was a bit sceptical about it actually working - but if it's more reliable than OPKs I guess I should give it a go! Do you only get the temp spike if you actually ovulate, or can it give a "false positive" like OPKs can?

minciepie

OPK's are of no benefit at all when it comes to PCOS because these kits measure levels of LH. Many PCOSers have an excess of this hormone in comparison to FSH so the kit is more than likely in your particular case to read such an excess and thus giving a false positive result. Multiple positive OPK results are commonly seen in women with PCOS. It is also unlikely that you're always ovulating around 14 days before the start of your next period.

I would chase them to have your blood tests done asap. You should have a day 2 done to measure and compare your LH level against that of your FSH level; LH is often higher than FSH in PCOS patients.

Clomid is usually the first line of treatment when it comes to PCOS but this should be given with a degree of caution to women with PCOS as it can affect their hormone levels markedly. In any event you should be monitored if put on this drug treatment as its quite powerful stuff.

Will GP now refer you to a gynae at a subfertility unit?.

Attilla but I've never had multiple positive OPK results... I get all negative results, and then a single positive result, and then I get my period 14 days later. So I thought maybe OPKs are reliable for me even if I do have PCOS?

Admittedly, I haven't continued to test after I get the positive result - so maybe I'd get extra positive results after that... will try this month and see.

Yes I think I'd probably better just wait till I have the blood test results.

I've got the forms to get the blood tests done, just waiting for the right cycle days. I've got one lot that need to be done on day 2/3 (which won't be for another 3 weeks) and then another lot that need to be done 1 week after ovulation. But if I can't rely on OPKs then how do I know when ovulation is? I guess I'd better get a thermometer & chart pronto...!

I think the GP did talk about Clomid being the next line of treatment if I did turn out to have PCOS. Bit worrying to hear it needs caution with PCOS though, I will have to read up about that. I'm not overweight so don't know if metformin/low GI is relevant to me? anyone know?

oh and thank you all!

I have just been described with borderline PCOS and have used OPKs in the past (before diagnosis) and never got a positive, despite higher than normal levels of LH, which I am thinking now is just weird!! Sometimes I did ov and sometimes I didn't! My cycles have been horrific (longest so far 77 days!). Have my appointment with the gynae in Jan!! mincie do you have any of the other symptoms of PCOS (if you don't mind me asking!)?

While I am here, can i just ask all you wise ladies out there a PCOS question? As i said, I have my gynae appointment in Jan, will they prescribe medication or can I get this from my GP??

Hi mince :)

I don't believe you can get a persistent raised temp without having ovulated, no. And I also recommend FertilityFriend as it's free (though you get a trial of the paid-for version but you don't really need the bells and whistles), and very reliable.

My GP told me it's a common misconception that women with PCOS have problems conceiving. Yes, some do there's no doubt about it but several of my friends and myself included have conceived with no problems at all despite being diagnosed as having polycystic ovaries.

I took metformin with my first pregnancy to regulate my cycle and conceived in the first month of trying. This time around (at at 39) my DS was conceived without any medication and was a bit of an 'accident' tbh.

Don't panic just yet.

Thanks Popcorn, I will look into thermometers then so we can time the SWI right. Bit miffed that all my weeing-on-sticks may have been misleading!

Mooley how did you know you ovulated if not by OPKs, were you temping/charting as well?

Yes I have one of the other symptoms - bad acne - but not the hair or the weight. And my cycles aren't terrible. So I guess maybe I am borderline too? I'm not sure exactly what the scan showed, won't find out till I get to see the GP, the receptionist just said "PCOS".

happy that's interesting. I guess I'm just impatient - 6/7 months ttc is not that long I know.

Hi there just wanted to share my PCOS story, hope it will be of some help to you.

I was diagnosed with PCOS back in 2008. I was, and still am only BMI 22, my skin is fine and I don't have excess hair etc, so you would think not a typical case. My main symptom was irregular periods. I was originally referred to a consultant for the scan and diagnosis who suggested I go on the pill (Yasmin) as I wasn't ttc at the time.

So we come to 2009 and DH and I decide to ttc and wham first month off the pill DS is conceived and all is well so I was clearly ovulating and an OPK DID pick that up.

So we come to present day, we are ttc number 2 and have been for 10 long months I naively thought it would be that easy second time around but no, sadly not. I started temp charting almost straight away, and used OPKs and from both of these I could see I was ovulating just really really late (CD30ish) which made for extremely long cycles.

Back in May I had a miscarriage, and since then I have had 2 chemical pregnancies so just last week I had an appointment with a private fertility clinic to go to talk to a specialist about PCOS and ttc (GP was royally useless).

What the consultant explained to me was extremely interesting. He said that the current thinking was that PCOS stems from insulin resistance which in turn causes an increase in testosterone in your body and a general imbalance in other hormones which causes ovulation issues and the other symptoms. He has prescribed Metformin which I am taking 3 times a day. He said that this will regulate my cycle by stopping the insulin resistance interfering with the hormones IYSWIM. As I said I don't have any weight issues so it wasn't prescribed for that reason - it was purely to help with ttc. He also said that he thought my early losses could have been due to the PCOS too and said that I should stay on the Metformin until 12 weeks when I do conceive again to help to reduce the mc risk.

I have also been given Clomid to take next time I get a period (if we don't manage it this cycle of course!). His explanation for this was that even though I am ovulating naturally the Clomid will encourage ovulation at a more "normal" time which apparently reduces the risk of poor quality eggs (what a horrid phrase) which are sometimes released with such late ovulation.

All in all it was money well spent - as I had previously been diagnosed I didn't need any further tests so all it took was a consultation and a prescription and hopefully we are now on our way to a successful pregnancy.

The consultant said that GPs can prescribe Metformin but many don't know much about PCOS so they are reluctant to prescribe it for that purpose unless it is clear that the patient is clearly in need of weight loss. I would push for a referral to a specialist if you can, this is a complex condition.

Anyway, sorry for rambling - bottom line is I have PCOS, I am ovulating (but late), I did conceive DS easily but I am having issues this time around, OPKs DO work even if you have PCOS (especially if combined with temp charting) and Metformin and Clomid could help even if you are ovulating naturally.

Phew, sorry that was longer than I intended.....

I was diagnosed with PCOS when I was 21. I wasnt ovulating at all, or indeed having periods.

I lost weight (from 13st to 11st 7, so still a BMI of 28) and my periods started coming back - around every 32-35 days. However, my basal temp never rose (I used Fertility Friend) and blood tests showed my CD21 score as 2 something. (ovulation is anything from 30+)

I had a HSG to check for blocked tubes, and numerous scans. Once given the all clear I took clomid - 50mg day 2-6. That first cycle I fell pregnant, and my DS is now 5.5.

I then had the lack of periods again, and had gone back upto 13st. I lost weight down to 12st - and then found I was 7 weeks pregnant with DS2 completely naturally. He is now 3.5.

Weight is a major thing with PCOS - low GI/carb diets can really make a difference.

Before clomid you should always have your tubes checked for blockages - you can only be on clomid for 6 cycles or so so you dont want to waste them.

I only have some elements of PCOS. I have moderate cysts, acne and a weight problem. But my gynea said I have a very mild case compared to some he sees.

Definitely invest in a thermometer. Set your alarm for the same time each day, shove the thermometer in your mouth before you get out of bed and record it. It should have a big jump and stay high when you ovulate.

I presumed I was ovulating with a 32-35 day cycle, but blood tests showed I wasnt.

Oh and one more thing - someone kindly pointed me in the direction of this which explains the insulin thing better than I can...

Thank you both!

Poppyjen what you say about conceiving first month off the pill is very interesting. I also know someone who has PCOS, who conceived accidentally having missed a few pills. I wonder if it might be that the pill "corrects" the hormone imbalance that we get with PCOS, so actually makes you more likely to conceive while the pill chemicals are still in your system?

Also interesting what you say about low quality eggs because of late ovulation.

Hope you get your bfp soon .

My GP is thankfully excellent and seems to know lots about PCOS, she has already mentioned a lot of this stuff about testosterone, insulin, clomid, metformin to me but I must admit it didn't really mean anything to me when I saw her before, so now I need to go back and listen properly

smokin how do you get your tubes checked for blockages? I had a pelvic scan which is what showed up the PCOS, would that have also checked for blockages or not...?

Blocked tubes tend to be checked with a HSG. They insert a dye into your womb and tubes and then under a scanning machine check that it flows. Its not the most pleasant experience (and can hurt) but is worth getting done.

I wonder if it might be that the pill "corrects" the hormone imbalance that we get with PCOS, so actually makes you more likely to conceive while the pill chemicals are still in your system?

No, if anything the pill masks the symptoms of the underlying hormonal problem that has always been there. Also the causes of PCOS are still not fully understood.

PCOS is a very individualistic disorder and affects each woman with it very differently. The commonality though is the cystic follicles on the ovaries. These do disappear - only to be replaced by further cystic follicles. Some of these follicles pump out hormones further disrupting ovulation (that is also why OPKs are of no real use in women with PCOS), some are dormant and others may contain an egg. Some women with PCOS do ovulate occasionally and spontaneously as well BUT most will need some more help in order to conceive.

If your Day 2 test shows the LH/FSH imbalance (i.e excess LH level compared to that of FSH) then it is likely that your Day 21 will also show no ovulation as well. In my particular case my sky high LH level put me at greater risk of miscarrying. LH and FSH are two very important hormones as they kickstart the ovulation process.

Would not place too much emphasis on temp charting particularly if you end up with a very difficult to interpret chart. Many gynaes as well do not take much notice of such charts primarily because they can be unreliable. I would go by the ultrasounds and blood test results rather than a single positive OPK result as these are far more accurate. Also using OPKs every day can cause you yet more stress in an already difficult situation,

Not every women with PCOS is actually insulin resistant (yet another conumdrum) so you may or may not be prescribed Metformin by a consultant gynae or be given a met/clomid combination (this can work well for PCOSers rather than just clomid solely).

If your periods are really irregular as well, the tests can be done according to calendar days (i.e the 2nd and around the 21st of the month). These tests should be repeated and you should have regular internal ultrasounds to further assess the state of your ovaries and uterine cavity (lining can be very thin in PCOSers).

HSG test is a tubal x-ray. It is a useful test to have done as it can give information not usually accessible by other methods. Deformities INSIDE the tube can only be seen on a HSG. It should not hurt providing the dye is injected both slowly and carefully. The staff should give you a couple of painkillers beforehand. If you have a HSG sanitary protection should be used post proceudre as that dye (only about a teaspoonful is used) comes out!.

If you are not already under the care of a gynae at a subfertility unit you should be. Some GPs are pretty much hopeless when it comes to PCOS and many such cases require careful management.

Try and remain within the correct weight range for your height; PCOS symptoms can be worsened by excess pounds. Many women find a low GI/GL eating plan helpful as this is more sustainable to do longer term than say low carb.

Thanks again. I am learning a lot!

Hmmm so if OPKs aren't reliable and temping isn't either, how do I tell when I ovulate each month? I need to know this month so I can time the blood tests right. Though maybe I should just take a guess and go on about day 30? (last cycle was 40 days)

For SWIing sounds like we'd better use the "every other day throughout the month" approach. So far we've been focusing our efforts around ovulation time according to the OPKs, and not so much at other times of the month, so if the OPKs are wrong that might explain why I'm not pregnant!

I'm not overweight - I'm 5'3 and about 8.5 stone so BMI in the middle of the healthy range I think - so that's one positive I guess. I've never put weight on particularly easily so maybe I don't have the insulin issues... Definitely got the acne though!

Right, next step is to get the blood tests done, then speak to my GP and see if she will refer me to subfertility unit

minciepie as I said OPKs and temping worked for me - and I know that I have been ovulating (miscarriage and 2 chemicals back this up too). I know that nothing can be 100% certain (apart from a pregnancy of course) but if you have found that you have had positive OPKs, and then AF around 2 weeks later in the past I would suggest that you try temping and see whether the temp rise and the OPKs tally up.

Temping is reliable as long as you remember to take your temp at the same time each day and before you do anything else (even talk). So keep the thermometer next to your bed and set an alarm. OPKs are reliable too - the main concern with women with PCOS using them is that you may get several positive results. I have never had this and sounds like you haven't either. I would say that even if you did only one of the positive results would tie up with the temp rise so that way you would cover your bases if you see what I mean.

The reason that health care professionals don't think temping is reliable is not because it doesn't work, it is that they don't trust us laypeople to be able to do it with sufficient accuracy (i.e. to do it at the same time every day to make it true basal body temperature). The fact is that it does work, it is as reliable as you can get without constant scans and blood tests and is an easy way for you to feel like you know what is going on

My consultant's specialist area is PCOS, and he has written extensively on the subject and lectures on it. He was an absolute mine of information. He said that a lot of interesting new research was coming through about PCOS and basically disproving some of the earlier research regarding LH levels completely - which means that the old advice regarding the unreliability of OPKs for PCOS women is not true.

He also said that there are some interesting early results suggesting that PCOS is always linked to insulin levels and that cystic ovaries are only one symptom that MAY be present and that it is possible that even men could have it (not cystic ovaries obviously but the same hormone imbalance caused by insulin resistance). This is backed up by the fact that women who have no cysts on their ovaries can have PCOS, and women who have lots of cysts may not have it.

I would say give temping and OPKs a try, you have nothing to lose

OK! I am going to keep weeing on the sticks and will get myself a thermometer too. can put the thermometer in when I press snooze on the alarm

thank you! your consultant sounds like a mine of information.

he was great, I can highly recommend him. If anyone wants to know details of the clinic PM me.

It was so refreshing to talk to him after months and months of GPs telling me that I just had to wait it out and in the meantime to lose weight (I am 52 kg at 5'1 so not great advice really )

Anyway, good luck - I hope you get on with charting, I found it fascinating. Fertility friend is really good.