First fertility clinic appointment + PCOS. What will happen?

[Nightfall1983]

This week I have my first appointment with the gynaecologist at the fertility clinic. I've been diagnosed with PCOS by my GP through blood tests and ultrasound. I haven't had a period for nearly 7 months but want to TTC. Can anyone tell me what to expect from the appointment? I haven't been asked to do or bring anything - if they anything you'd recommend I bring? It is just a chat or will they likely to an examination/scan/more blood tests there and then? Is there any chance they will prescribe something to make me ovulate at the first appointment?

FYI I do already have DS who is 2.5, conceived naturally after a year of trying. My BMI is (very) high at 33.

Hi, new to this first message!

I too have pcos but do ovulate regularly, I had my first appointment with gyn In dec, he arranged for some bloods to be taken an Hsg scan (dye test to check tubes) and an internal scan, I've had my dye test and all is well with my tubes, I'm there again on the 22nd of this month all being well will be starting clomid. Although I will say you if you are over weight they may suggest losing some before providing clomid.

Sorry not much info there but I hope it helps! :)

My experience was pretty much the same as bec
Although I didn't have to have the dye, I think that is down to me already having a DC.
We discussed what would happen next and in my case it was bloods, scan and then clomid.
Has your partner had a sperm analysis done? My consultant wouldn't prescribe clomid until DP had been checked.
Its also a good idea to write down any questions you may have, I've found the second I walk in the door I forget everything I wanted to ask.
Good luck

I would definitely recommend taking your dp and a book with questions in and a pen to write down the answers. On my first appointment I thought it was an intro type thing so I went alone. Consultant talked me through the process, different options and gave me a few things she wanted to do. I forgot most of it as soon as I left.
First appointment was a lot of info and a blood test, along with a referral for another internal scan, HSG, follow up bloods, a prescription for metformin and dp to have his sperm checked. Good luck!

Thanks for you advice all, sounds rather more complex than I was expecting.

I was hoping that since I'd already had a child (with my DH) with out assistance and just need some help to start ovulating again it would be simpler but maybe not.

DH has had a sperm test done, but it was several years ago when we were TTC DS. He really can't come with me this time (appt is Wednesday and he'd need to book a morning off work). Will just have to see what the consultant says I guess but I really, really don't want an internal exam. I had a minor phobia about them, internals during labour left me with minor PTSD :(

Have you got someone else you can take with you?
Your OH will need another SA done.
Ive havent an internal at all but part of the scan was internal

Sorry to ask questions on your thread. My second app is on the 22nd of this month, what can I Expect then? The gyn told me all being well with other tests they would proscribe clomid, I was really excited about starting this, however my one and only comment on my post was from a lady stating that clomid doesn't help people who already ovulate, I do ovulate on my own but my gyn does think that taking clomid will make ovulating more predictable, I guess I'm asking if anyone else as been proscribed clomid when already ovulating?

Again sorry for invading this thread! Only signed up yesterday so still learning! :-/

Well tomorrow is the day for me so I guess I'll find out soon :) I haven't got anyone to take with me - my DM is kindly babysitting DS otherwise I'd have to take him too. I'm sure I'll be fine, I'm not anxious about the appointment but I will be sure to bring a pen and paper.

hijack away Bec I don't mind. Actually can I ask when your last appointment was if your next is on the 22nd? Just wondering how king they leave between appointments really...

So a report for information for anyone following/in the same situation (and it helps me to get my thoughts down).

Very friendly Gynaecologist, asked me a hundred million questions as expected. She had the results of my previous blood tests and ultrasounds scan, all fine (well, all indicative of PCOS but otherwise fine) however since I'm not having periods I wasn't able to have the "day 2 - 5" blood tests so she prescribed me Norethisterone which causes what she called a "withdrawal" bleed (similar to the bleed between pills I guess) so that I can have that blood test done and gave me the forms for the test too. She said that when I go back for my next appointment I need to bring the results of DH's sperm analysis (so we will need to go to the GP for a form for that). She said my BMI needs to be under 30 to go on Clomid which is fine and feels more achievable than 28 which I'd hear previously - I've already brought it down from nearly 35 since the beginning of January).

She initially said I would need to have the dye-test to check tubes but after talking about it she suggested we hold off on that till I've been on Clomid for a few months - its relatively invasive and not particularly pleasant and all signs indicate that Clomid should work for me. She said I can have it done straight away if I wanted but I'm happy to wait. She did perform a quick examination and took swabs for analysis.

The next available appointment isn't until September (!) however both the doctor and the receptionist advised that I should call up to check for a cancellation appointment once I have achieved the required BMI (about 2 months hopefully).

I think that's it; a busy appointment and covered a lot more than I was expecting but overall good and I feel ok about it.

"Hi Nightfall,

You may find Verity's website on PCOS to be useful to you www.verity-pcos.org.uk. Educate yourself further re PCOS as this will also help you when it comes to making treatment decisions.

I would ask them further about the day 2-5 blood tests.
Blood tests can actually be done according to calendar days if the cycle is non existent so the day 3 test could be done on or around the 3rd day of next month.

Your DH needs up to date test results re his semen analysis particularly as that was last done several years ago. Infact any test result done over 6 months ago should be discounted. His semen analysis should ideally be done at the same place where the sample will be analysed; you do not want to be driving through traffic to deliver the sample as such do go off very quickly. Also such testing should always be done more than once.

Well done for getting your BMI still lower, weight however should not in itself be a barrier to treatment. Did they not mention Metformin?. Re clomid, it should be used with a degree of care to PCOSers as it can affect hormone levels markedly, you should be monitored whilst on this ideally with both blood tests and ultrasounds.

I sincerely hope you can get a further appointment before September as this is really too long to be waiting; you need to be seen at least once a month and by the same team of people as well. Continuity of care is vitally important.

I have had the dye test done that was described to you and am happy to give you more info on it should you so wish.

Your DH should really attend this next appointment with you if at all possible. They need to see him in any event.

Hi Attila, I also have to go for the dye test and transvaginal scan, would you be able to tell me more? Feel quite anxious. I have only had one app with the consultant and he thinks I may have pcos due to my blood test results. Thank you.

Thanks for your thoughts Attila. I will check out that website.

RE the day 2 - 5 blood test, you may well be right however I've already started taking the tablets which will 'force' a bleed so I may as well continue - if for any reason they need to be repeated in the future I may bare it in mind though.

Metformin was not mentioned - is it an alternative to Clomid? I will research - does it have the same effect? If so I will discuss when I go back and I will also be sure to ask about monitoring/affect on hormone levels. I had already been warned that most trusts don't start fertility treatment until your BMI reaches a certain level (usually 28 I was told). I believe this is because higher BMIs can be linked to problematic pregnancies. In any case I'm happy to lower my BMI to 30 before commencing treatment, it is quite achievable for me and I would like to be smaller before getting pregnant again - I was much smaller in my first pregnancy and have a very easy time of it - this time I will also have a toddler to run after :)

I don't think there is any chance of being seen once a month - that's just the way it is in my hospital. I guess I could complain but in my case I'm sure it will be fine, it will take me a couple of months to loose the weight and then I'm hoping to get a cancellation appointment. I'd rather not wait until September but will if I have to - I'm not terribly desperate.

RE DH sperm analysis. I don't really understand this. We already have a child, conceived naturally. The only time he's had a SA done it was good. Yes we are having difficulty conceiving but I'm not having periods and therefore not ovulating! Surely it would make more sense to assume that's the (main) problem and get on with solving it? Yes if after a few months on the Clomid (or whatever) we are still having problems then it would make sense to check him out - I know that sperm can and does change dramatically from 'time' to 'time' and its possible that both our son and the SA were just flukes but realistically it seems unlikely and a waste of time and resources. Realistically I'm not releasing eggs - investigating his sperm isn't going to help. Sorry for the rant, he will of course get the SA done so I can take it to the next appointment (which I'm really not planning on asking him to come to - again I'm just not ovulating, nothing he can do will help). PS as I understand it he will get a form from the GP, take the form to the hospital or wherever and provide his sample there and then - that's what happened with his last SA anyway...

Anyway I appreciate your advice and you may well be completely right - I'm allowing myself to keep my head in the sand a little longer, I sincerely hope that it'll only take a couple of month of Clomid to get me ovulating and I'll fall easily. I'm also somewhat hoping that before long my continued weight loss will get me ovulating again (I had no/few PCOS signs prior to gaining weight over the last couple of years) and all this will become mute.

Hi Nightfall,

"Re DH sperm analysis. I don't really understand this. We already have a child, conceived naturally. The only time he's had a SA done it was good. Yes we are having difficulty conceiving but I'm not having periods and therefore not ovulating! Surely it would make more sense to assume that's the (main) problem and get on with solving it"

Indeed but it is little point solely testing you now only to potentially discover later on down the line that there are male factor issues as well. This has happened on here before; secondary subfertility equally in both partners is not unknown. Both of you therefore should ideally therefore be tested in tandem. He last had an analysis done several years ago and he should ideally have an up to date test result and I hope his forthcoming result is a good one. It cannot be readily assumed that because he has already fathered a child there is nothing wrong now with his own fertility.

Metformin can be prescribed to PCOS patients in conjunction with clomid and it can also help with regards to insulin resistance (which some but not all PCOSers have). It can also assist with lowering both insulin and blood sugar levels in women with PCOS. It can sometimes assist in ovulation with women who do not respond to clomid alone (some feel that clomid and metformin used together can show more success overall).

I wish you both the very best of luck going forward with all this. I was diagnosed with PCOS (and endometriosis as well) around 20 years ago and am a parent.