Fertility hosp appt tomorrow? What should I ask? Pcos but regular ovulation

[yellowflowers]

hi,

Pcos but regular ovulation (shown by temp charts) periods always 30 days or 38 days, been on 1700mg metformin for couple of years now (pre ttc as doc said good to start early). Presumbly clomid no good if I already ovulate. So what can I expect drugswise and test wise. And what questions should I ask.

Appt is tomorrow am so have left if a bit late to ask but have just started to feel incredibly apprehensive about it. (dh can't make tomorrow but is happy to have sperm tested)

I am 30.

Thanks.

Day 21 test again, they will advise you to lose weight if you need to, Clomid can increase likelihood of number of eggs released I think, which obv means more chance of twins but also more chance of single conceptions.

Ask about routine schedules (ie how long before IVF is offered).

If your DH has not had a sperm test he needs that to see if the problem may lie with his swimmers rather than anything else.

It's unlikely they will examine you in any way other than perhaps a blood test.

Take your diary if you have one, they will want to know period dates etc.

Thanks. If just blood test presumably they see you again when results in to decide what next?

I have PCOS too. They took swabs at my first fertility appt to check for any infection and also arranged for me to have a day 21 test. They also booked me in for a laparoscopy at the same time (so before they knew what the blood tests would reveal)

Good luck for tomorrow.

They will review your history, take some blood, take some sperm and then call you back - probably in a month to review the results.

BTW good luck. It may be irksome to you but it's everyday to these folks, so don't worry!

Thanks both. Had really hopes I'd get pregnant this month in one of those 'I got an appt but never needed it' stories, but alas started spoting today so period about to start.

Hi Yellowflowers

Re temp charts re ovulation - they may actually be wrong. Do not assume ovulation has occured on that sole basis. Charts and PCOS are also uneasy bedfellows and can mislead.

The surest way of knowing whether ovulation has occured or not is to have blood tests done on a regular basis. You should be also followed up regularly and not left. You need to see what your LH and FSH levels are like in relation to each other (that is usually done through a day 3 blood test). With PCOS there is usually an imbalance of LH to FSH. I would also think they will do a series of blood tests and internal ultrasound scans to assess the state of your ovaries and uterine cavity.

Your periods would also be seen to be irregular because there is more than 4 days of variation from month to month.

How is the Metformin working for you, has it helped?. Many but not all PCOSers are insulin resistant.

Metformin and clomid can work well together; however, if they give you clomid ensure you are monitored whilst on it. It is a drug that should be given with a degree of caution to PCOS patients as clomid resistance can happen.

Verity's website may also be helpful to you - www.verity-pcos.org.uk.

Am sorry to read that your H cannot come along with you to the appt today, the moral support he would have given would have been helpful to you. On a wider note it is vital that the three of you can work as a team and communicate.

Write down anything you want to ask them today well ahead of time (no matter how daft it may seem). You do not want to come out of there thinking, "oh I should have asked about x". Do ask lots of questions and get firm answers. Take notes!!. Ensure that you are fully aware of what tests are being done and WHY such treatment options are being suggested/

Hi Yellowflowers,

You may also want to ask about injectible drugs and laparoscopic ovarian diathermy (this is slightly different from a laparoscopy which can be just exploratory) as these can be helpful for PCOSers as well in the event that clomid is unsuccessful. You need to know what their scheduled treatment pattern is.

IVF won't necessarily come into it, other treatment options tend to be more helpful for PCOSers and IVF should only be tried in the event that all other treatment options have failed. IVF for PCOSers is not without its own risks in terms of ovarian hyperstimulation.

Your H should also be tested in tandem with your own tests early on to rule out or confirm any male factor problems.

Oh yes, they may book you in for a hysteroscopy to see what's going on inside as well, forgot to mention that bit.

hi all,

just back from hospital appt. Can't say I warmed to the consultant but it was okay.

He's ordered day 3 bloods - for FSH, LH, Estradial, Prolacton, TSH, Rubella, Testosterone, DHT, SH and BG - anyone able to shed light on any of that do please tell me (I know FSH and LH)

Also a day 21 progestorone to be repeated a week later in case this is a long cycle.

Also a scan. Also DH to have semen test.

He thought HSG better than laparoscopy but to wait until after next appt so we can review blood tests and scan results first. Next appt is end of August unless I can get a cancellation sooner.

He said clomid a possibility for the future and can be used at my weight but that I need to lose weight before they will refer for assisted conception.

I'm to continue using metformin including if I conceive.

So all good except I am so pissed off period started today so feel a bit glum.

I would say I didn't feel dh should have been there as it really was just talking through stuff largely that I already know. I want him to save his time off for accompanying me to any more invasive procedues.

xx

yellowflowers - I could never understand why the consultants were so frosty either until I realised they were basically trying to solve problems which in a lot of cases they would be unsuccessful at and everyone blames them. Not saying it's anyone's fault but you can't blame them for being a bit brusque when they have five minutes to see each person and a full examination takes 20 etc......

Are they going to give you (other than Metformin) any form of medical help to lose weight? How much do you have to lose?

Don't be miffed about periods - if you don't have them, you don't ovulate. It's actually a sign of fertility that they happen

Hi yellowflowers

This is a useful website re hormone levels:-

www.fertilityplus.org/faq/hormonelevels.html

He's being thorough with these blood tests. Some women with PCOS can produce excess levels prolactin. Excess prolactin levels can interfere with ovulation.

Some women with PCOS also produce an excess of testosterone.

Increased androgen levels often leads to lower SHBG.

You don't want keyhole surgery like a lap unless it is actually called for. Also diathermy would perhaps be a better bet than a standard lap op which can be diagnostic only. HSG is a tubal x-ray and is a useful test to have done as it can give information not easily accessible by other methods (for example a lap).

BTW one semen analysis may not be enough to confirm or rule out male factor problems, these tests often need to be repeated.

You ought to be seen earlier than August as you need the results of the blood test asap.

thanks whomovedmychocolate and attilla - I would say this particular consultant def hadn;t been to charm school but I am pleased he's been through and it's not a new friend I want after all but a baby...

He said the prolactin test might be able to see if there's a reason for my sore boobs too (all month this month).

August was the first appt they had - consultant wanted 3 months time so that would be beginning of August.

Thanks also for link attilla.

The only thing I couldn;t really get out of him was if the blood tests do show hormone imbalances then how are they addressessed/treated?

Blood tests only capture a snapshot of where you are at a particular point so they may not be too helpful TBH. It's interesting that you have sore boobs every month.

If I may ask a blunt question, are you very overweight? It's possible the fat in your body is producing so much oestrogen, your body won't support implantation, let alone a pregnancy? I was bloody annoyed that no-one told me this when I saw consultants, they talk around it but don't come out and say it - I wasn't even that overweight but once I lost weight I not only ovulated but got proper cervical mucous. I also lost my sore boobs.

Glad it went well today and your consultant is being so thorough.

I get sore boobs every month too and there is definitely a link with my weight. Over the last year I have lost a couple of stones (since I've been on metformin) and my sore boobs stopped. However I have put some weight back on recently and the last two months have had sore boobs again.

It's also interesting that they have told you to continue with the metformin if you get pregnant. My consultant has stressed that I am to stop it as soon as I conceive. I have read that there is evidence that taking metformin can reduce the risk of miscarriage in PCOS sufferers. As I have had two miscarriages I am keen to try anything that will help! Did your consultant say how long you should carry on taking it for?

Hi whatsfortea and lubyloo. Yes quite overweight. Size 18 on a good day but I fluctuate and am sometimes 20/22. Interesting about link between weight and site boobs.

Didn't say how long for metformin post conception but I think I have read 12 weeks elsewhere.

Did you do anything special to lose the weight lubyloo?

No I didn't really do anything special to lose the weight. My diet was already fairly healthy but I used to get very bad sugar cravings that I gave into. When I first started the metformin the sugar cravings went and so I stopped eating sweets etc. I did try and follow a low GI diet.

However, I have been very bad the last couple of months. Have not been eating low GI and so the sugar cravings are back and the weight is piling on. It is a vicious circle!