Clomid success with possible PCOS/perimenopause ?

[erilou38]

Hi all. I'm 38, will be 39 next March. I'm currently under an NHS infertility clinic as iv'e been trying to conceive for over a year. I had a scan in August with showed a have a few ovarian cysts. The nurse said it could be PCOS as at my last blood test showed elevated levels of E2 hormone. My FSH was 5.2 in the normal range. Iv'e been having irregular periods for sometime also and they are lighter than they used to be. My GP thinks i could be in perimenopause as i had a high FSH reading a year ago, it was 20! I am somewhat confused as nobody is too sure if it is possible PCOS or perimenopause that is causing my infertility. I have children whom i had no trouble conceiving, fell pregnant in the first month of trying. My youngest is 7. I'm desperate for another child. Just wondered if anyone has had any success stories who is 35 years or above with taking Clomid ? Have you been able to get pregnant with Clomid while having PCOS or being in perimenopause ? Also, i am having trouble with vaginal dryness. Could this be a symptom of PCOS or more likely the dreaded menopause ? My doctor says that maybe the PCOS is causing the dryness. I'm so scared i'm in menopause!!!! Iv'e been told i can't have IVF on the NHS as i already have kids and i couldn't afford to go private so Clomid would be my only hope! Replies much appreciated, thanks.

Hi erilou

First things first, ask for a referral to a specialist. You need to see someone with an interest in gynaecological endocrinology (not a standard gynaecologist - they are normally surgical and you need to see someone medical - or at least with an interest in the medical side).

You need to specifically have day 2-5 LH and FSH bloods done, as well as oestradiol - this will help to determine whether you're looking at PCO (you can have PCO morphology without having PCO syndrome and it is important to ascertain this) or perimenopausal. Keep a very clear record of your cycles - day one, how long bleeding lasts for, any spotting etc during the cycle. I'd recommend that you have these done via your GP if you can as this will save time once you are referred.

Clomid can definitely be given at the age of 35 or over, reasonable success depending of course on an underlying diagnosis.

It is very important that you are the right weight - BMI should be between 19 and 30 - if you have PCOS then you might find that it is difficult to achieve this. The good news though is that, if you can get your BMI within this range, then you are much more likely to conceive. If weight loss doesn't work then it makes clomiphene more likely to work.

I know that a lot of women take metformin, but I would warn against this in the first instance. In fact I think tamoxifen can also be used for ovulation induction, as can GnRH injections (but these would have to be self funded and work out at about £1000 per cycle - it is hugely specialist so you would need to be very picky about who you see). If ovulation induction is appropriate and you have a choice then go with clomiphene.

If you do have clomiphene then you will need to be monitored closely - typically you will start at 50mg in the first cycle, then with monitoring you should stick with this dose or try higher/lower doses depending on how you respond.

Don't lose hope, but get thee back to the GP for more accurate testing and onward referral.

Sorry for the essay - feel free if you want to PM me