Pardon the puns this early in the morning, but I have a chest cold/flu-like something from hell, and the last of my Nyquil hasn’t worn off yet.
Despite feeling like my chest cavity was being trampled from within by angry infertile midgets yesterday, I made it in to Dr. Good Eggs who really was a “good egg”. Probably one of the kindest, most attentive, and compassionate doctors I’ve encountered. And young and handsome to boot! He certainly lives up to his reviews. Speaking to a professional who knew his way front, back, around and upside down PCOS was very comforting.
After spending over an hour (!!) reviewing my charts with me, he let me know that based on the blood work I’ve had to date, he suspects that insulin resistance is my primary reason for anovulation. He stressed that it was imperative that I try Metformin (again) and that I stick with it for up to 6 months. I explained the intestinal issues I’ve experienced on it, and he says he wants me to try a very slow ramp up this time, taking about 1 month to get up to 1000mg, and then another month to get up to 2,000mg. He said I could try the slow release formula, but that the clinical studies he’s seen show much stronger results with the standard release formula, and I said, “bring it on”. If I’m going to do this, I’m doing it right. In the meantime, he is having me do a 3 hour fasting glucose/insulin test that is only done between days 1-10 of my cycle (I forgot to ask why!)–I’ll have to wait a couple more weeks for that one until I get my period from the pill. He’s also giving me a very sensitive testosterone test, as he said my levels are very high right now (62 free) but he’s not sure what sensitivity the test I had was. He says at their lab, anything over 35 is considered high.
He wants me to wait until after my glucose challenge to start to Met so we know my baseline numbers. In the meantime, he says that a round of Clomid should be fine with or without the Met.
And now for question time!:
1. Looking at my ultrasounds and the fact that my ovaries are covered in cysts, how will that effect ovulation moving forward. Will my cysts block future ovulation?
It was once thought that cysts could actually block future ovulation from occurring, but it has been shown that this is not the case. In other words, just because your ovaries are cystic landmines of ASS doesn’t mean that with the right meds, you won’t be able to pop out a good egg.
2. Most of my results are in the borderline “normal” range–this means they are often one or two points off from being too high or too low (my A1c test that measures my blood glucose levels over 3 months is one point away from being too high). My question is: is a borderline “normal” number the same as a low high number? My thyroid, Vitamin D, and DHEA numbers are also borderline.
The borderline numbers are not an issue. He wasn’t too concerned with any number except my glucose levels.
3. Has he seen women with this severity of PCOS get pregnant with Clomid or other fertility injectables, or is it generally through IVF. What has been the most effective form of treatment that he has seen for infertility in people with similar cases to mine.
Metformin has been very successful when taken consistently for long periods of time. He has also seen many women respond very well to a combo of Met and Clomid. Then again, he made no promises, and said that it’s hard to tell exactly how each body will respond to all of these drugs.
4. Does his course of examination/ treatment of thin women with PCOS differ from obese women? How so?
It’s not really about being thin or obese, it’s about what your goals for the treatment are. Many obese women have a goal of losing weight. In my case, it’s pregnancy–so he’s going to work with me in the best way he knows how to make that happen.
5. Has he noticed a correlation between frequent yeast infections and PCOS? If so, why is that?
Forgot to ask that question!
6. Are FSH levels that are not taken on Day 3 still accurate? Meaning, do they accurately reflect my fertility? I have been concerned because my FSH levels have gone steadily upward over the last 2 years, but none of my FSH levels were ever drawn on Day 3.
There is a possibility of inaccuracy if not taken on Day 3. He is not concerned with any of my levels (8.2 being the highest), but said that it’s good that I’m “getting the show on the road” right now.
7. Why did I have one ovulatory cycle after birth control? What did the hormone in the pill do to trigger my natural ovulation the month after I was off the pill?
There is still no definitive medical explanation for why the pill helps some women ovulate shortly after getting off of it.
8. My estrogen levels were very low after 4 months of not ovulating, and my uterine lining was basically non existant. What does this indicate? Has my body stopped producing natural estrogen? Are signals crossed? Are the receptors on my cells blocked by pill hormones? Will estrogen pills help build my lining? Would he recommend estrogen supplements if I were to go on Clomid?
Forgot to ask him this question too. Bad me.
9. Would it be wise to do a scan of my pituitary gland to see if there is a tumor?
No, he doesn’t recommend that at this point. My levels are not off enough to warrant it.
10. What about my thyroid? My numbers there are borderline. Could there be an issue?
My thyroid numbers don’t seem bad to him at all. He likes to see anything lower than 2.3, my lowest was a .78 but he didn’t seem concerned with it being too low. My others came in the low 1’s.
11. Does he have an RE he trusts to refer me to?
Yes, he referred me to two, both PCOS experts in their field!
12. What are the blood tests he finds the most informative when dealing with PCOS. Is there any that I am missing?
The glucose tests and the testosterone tests as well as the LH/FSH ratios are all important. Thyroid is too. I’ve had every important test except the 3 hour fasting glucose/insulin test that he recommends.I’m getting that test done any time between Days 1-10 of my cycle.
A little extra tidbit of info is that interestingly, the majority of obese women with PCOS don’t have skewed LH/FSH ratios, whereas the number of thin women with PCOS do. Mine are all at least 1.5/1 or 2/1 in some cases, when they should be 1/1. Weird!
I have a 6 month follow up appointment scheduled with him to see how I’m progressing. We will do another glucose tolerance test at that time to see how I’m responding to the Met.