Thoughts

[Dancingfairydreams]

Hello,

First time posting on this board, but I need some really honest advice.

Been TTC for 5 years now, have PCOS, only one pregnancy in that time which sadly ended in a ruptured ectopic, resulting in emergency surgery & the loss of a tube. That was May 2020. Have been TTC since October 2020....nothing since.

I've invested in a ovusense, which tells me I've only ovulated 4 cycles out of 19, and when I do ovulate I have a 6 day luteal phase.

I was seen by gynaecology in March 2021. I will admit I have a high BMI, 48, which I know i need to work on, but i really struggle with my emotions & tend to reach out for food.

I have had private bloods taken, 21 day test result was 1. AMH was 26.8. Partners SA was great. Last bloods were April 2021.

Now, I have an apt next week with the NHS gynaecologist, I know they'll mention the lack of weight loss. But would it be reasonable to go to this appointment & ask for the bloods to be repeated again, as its been 2 years?

Also, I'm concerned that I'm showing signs of Peri menopause, and partially if technically I'm not having periods but the bleeding I have is yet breakthrough bleeding? So I've not had a cycle where I've ovulated for 10 months now. Would it be wise to raise that question too?

I would also like to ask about metforim, as I understand this may help with my pcos symptoms & weightloss? Would this be an option? When I asked about medication in the past they only discussed clomid & said I couldn't have that due to increase chance of another ectopic.

Sorry, I've rambled lots but would appreciate any wise words. Many thanks

I think you're within your right to raise everything and request new bloods (but what are you expecting them to show that might be different?). Write a list of things and options you want them to consider and be prepared to have an honest, open conversation which is likely to heavily revolve around weight Vs fertility. Maybe ask them what they can do help you with your diet, especially if you feel you can't manage it on your own?

I have PCOS. I get it, it's hard to lose weight and easy to gain weight and hard to control those crazy cravings. But the honest truth is that you need to get your BMI down to get real fertility help 🙁. And annoyingly weight loss really does help with some of the symptoms of PCOS and might be all you need to start ovulating properly. Speaking as someone who has to have IVF and has made no progress with my weight since April, I know it's a really horrible truth and it's not as simple as 'sort your weight out' but you really need to focus on that if you're expecting any fertility help.
There's no miracle metformin that's going to automatically fix your emotional relationship with food. You have to do that yourself.
If they won't prescribe Metformin (my doctor refused to), I'd suggest taking an inositol supplement, as this is considered a "natural Metformin".

I guess if I were you I'd think about this: with the knowledge that they will consider your BMI an issue and the NHS has strict rules around BMI and what fertility support is provided based on your BMI, what are you hoping to achieve from your appointment?

Ask about Metformin. Also definitely mention the lack of a period - a period less than every 6mo increases your personal risk of uterine and endometrial cancers.

Ask about Metformin. Also definitely mention the lack of a period - a period less than every 6mo increases your personal risk of uterine and endometrial cancers.

Thank you both for your replies.

I guess the rationale for asking for the bloods again is to see how much things have changed & rule out anything else being a hindrance.

I think it'll also alleviate some of my worries around it all. But i am then worried about wasting an appointment, like you saying knowing they are so strict.

I need to get my head straight, I think alot of my issue is that I always kinda knew, from way back, this journey wasn't going to be easy, so I get down very easily & also get complacent, so what's the point in losing weight as it won't change anything etc? That's what I need to change!!

It's never a wasted appointment! You're worth the time and you deserve to do what you can and to discuss your worries and have your mind put at ease.
I only asked as it's hard to manage expectations and it's a little soul destroying coming away from these appointments having made no progress with getting help, with the same old "lose weight" being thrown around when all you've gone for it to ask for fertility support. But if your aim is as you say to see if anything has changed and if there's anything else going on and to talk about your worries then definitely do the appointment!

In terms of weight loss, that has to be up to you 🙂 what I will say is, you don't know if you don't try! What if weight loss is the answer and you didn't try to find out? And if you lose weight and still need a bit of help conceiving, at least you've done everything YOU can do.