Each month we host a free, live online seminar where patients can ask the physicians of Fertility Solutions questions about infertility. The seminar for September was about ‘ PCOS and treatment options beyond clomid ’. View the live Q & A chat about PCOS below:
PCOS: Treatment Options Beyond Clomid
(09/12/2012)
7:00
Welcome to Fertility Solutions interactive session on PCOS and treatment options beyond clomid
Wednesday September 12, 2012 7:00
7:01
PCOS is a condition which involves menstrual cycle irregularity, lack of ovulation, symproms of excess androgens (Acne and hair growth) and often is associated with weight problems and insulin resistance.
Wednesday September 12, 2012 7:01
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In a fertility clinic setting we often see patients who have irregular cycles and do not ovulate and therefore have a difficult time getting pregnant
Wednesday September 12, 2012 7:03
7:03
As many of you know CLomid is used to induce ovulation in patients with PCOS, but it does not work all of the time, nor does it treat many of the other symptoms.
Wednesday September 12, 2012 7:03
7:04
Other options are available for those patients who do not respond to clomid or cannot take it because of side effects.
Wednesday September 12, 2012 7:04
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Do any of the readers have any experience with clomid? please share..
Wednesday September 12, 2012 7:07
7:09
[Comment From JenniferJennifer: ]
I have experience with clomid… I took it maybe 3-4 cycles, i did seem to ovulate with it but never had a conception with it. I found that the side effects were a bit extreme but anything to get a baby
Wednesday September 12, 2012 7:09 Jennifer
7:12
Your experience is not unusual. Many patients suffer side effects and irritability seems to be the big one. Also because of its mechanism of action clomid can thin out a lining of the uterus. If it does that even if ovulation is induced, pregnancy does not happen Other medications can tried to induce ovulation. Recently a medication called Letrozole has been used with a lot fewer side effects
Wednesday September 12, 2012 7:12
7:12
[Comment From MelissaMelissa: ]
Side effects of irritability
Wednesday September 12, 2012 7:12 Melissa
7:16
Clomid may not work in one of two ways. It either does not cause ovulation or as we mentioned before it caused ovulation, but pregnancy does not happen.
Wednesday September 12, 2012 7:16
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Of ovulation does not occurr, clomid can be combined with other medications such as Metformin. Also Letrozole can be more effective in inducing ovulation
Wednesday September 12, 2012 7:18
7:18
[Comment From KrystalKrystal: ]
What would be recommended if clomid does not work?
Wednesday September 12, 2012 7:18 Krystal
7:18
[Comment From MelissaMelissa: ]
What are the most successful treatment options beyond Clomid
Wednesday September 12, 2012 7:18 Melissa
7:20
If clomid failed to result in pregnancy, typically we then recommend more aggressive methods to induce ovulation such as injectible FSH or even IVF. THose methods would be recommended only after an adequate trial of ovulation induction with the oral medications such as clomid, metformin or letrozole
Wednesday September 12, 2012 7:20
7:21
An adequate trial of ovulation induction would typically consist of at least 6 ovulatory cycles
Wednesday September 12, 2012 7:21
7:21
[Comment From JenniferJennifer: ]
What is there out there that will help maintain a pregnancy. I have been pregnant 5 times total but have miscarried 4 times. On 2 of those pregnancies i used progesterone
Wednesday September 12, 2012 7:21 Jennifer
7:23
I am so sorry to hear that. It is important to determine if there are other causes of miscarriage in your situation. It may not just be hormones such as progesterone that are responsible for your lossess. Patients with PCOS are a a increased risk of pregnancy loss, but typically do not have as many as you describe
Wednesday September 12, 2012 7:23
7:23
[Comment From JenniferJennifer: ]
What about if you have tried clomid, IUI, and IVF and all have failed.
Wednesday September 12, 2012 7:23 Jennifer
7:24
Obviously a difficult problem. It is important to examine each treatment modaility you have tried and determine if possible what is contributiong to the lack of success
Wednesday September 12, 2012 7:24
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[Comment From KrystalKrystal: ]
What can I do to help my body ovulate more regularly… would you recommend any supplements?
Wednesday September 12, 2012 7:25 Krystal
7:26
Dietary supplements such as d-chiro inositol and chromium have been shown to improven insulin sensitivity and restore ovulation in some patients with PCOS
Wednesday September 12, 2012 7:26
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[Comment From JenniferJennifer: ]
I have been TTC for 3 years and am about ready to throw in the towel. It has been a very long ride for me.
Wednesday September 12, 2012 7:26 Jennifer
7:27
I am so sorry to hear that.
Wednesday September 12, 2012 7:27
7:27
[Comment From JenniferJennifer: ]
I just went 3 months without a period which has never happened to me and would love to be regular on my own
Wednesday September 12, 2012 7:27 Jennifer
7:29
It sometimes can be achieved with alternative medication such as the supplements I mentioned. Accupuncture can be effective as well. If you are overweight, dietary modifications, particularly low carbohydrate diets are an important consideration and can be very helpful as well.
Wednesday September 12, 2012 7:29
7:29
[Comment From JenniferJennifer: ]
I responded poorly to my IVF cycle. I only has 11 eggs retrieved and only 3 that fertilized. I had all 3 put back in and none took
Wednesday September 12, 2012 7:29 Jennifer
7:30
That seems a particulary low fertilization rate. Were all of the eggs mature, is there a sperm problem? Do your doctors worry about egg quality issue?
Wednesday September 12, 2012 7:30
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[Comment From JenniferJennifer: ]
I’m not sure if this is common with PCOS but i was wondering if it is common to have sharp pelvic pain periodically with flank pain. I have been getting this more and more frequently but unfortunately i don’t have health insurance at the moment and haven’t been able to see a doctor
Wednesday September 12, 2012 7:30 Jennifer
7:31
Your symptoms do not sound typical for PCOS and if persistent should be evaluated by a physician
Wednesday September 12, 2012 7:31
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[Comment From joanne brownjoanne brown: ]
ive tried accupunture this past year, and after following their protocol with diet change, supplements, and other life style changes. i conceived within 3 months. although the pregnacy did not stick. i think my body just wasnt strong enough yet.. i remain hopefull
Wednesday September 12, 2012 7:32 joanne brown
7:34
THank you for sharing your experience. It is important to recognize that these alternative approaches can restore ovulation and help with pregnancy. Joanne, maybe the next step would be to confirm that your progesterone levels are high enough. You may be able to add a supplement to what is alaready helping you and help in the next pregnancy
Wednesday September 12, 2012 7:34
7:34
[Comment From JenniferJennifer: ]
I have had all necessary bloodwork done and an HSG but is there any other testing that i should have done?
Wednesday September 12, 2012 7:34 Jennifer
7:36
[Comment From joannejoanne: ]
i have had my progesterone tested and they say they were normal levels. i carried until my 11th week when they realized i had a molar pregnancy and needed a d &c
Wednesday September 12, 2012 7:36 joanne
7:38
Joanne, it sounds like it was an unfortunate event then and not likely to recur again. Keep your chin up and keep tryiing
Wednesday September 12, 2012 7:38
7:41
[Comment From joannejoanne: ]
what if you have a high testosterone level and thats one of the reasons for poor egg quality, is there a way to lower that level on a more natural level with a supplement
Wednesday September 12, 2012 7:41 joanne
7:43
High testosterone levels can come from either the ovary or the adrenal. It is important to determine the source. There are not a lot of good options to lower testosterone naturally, but the supplements we discussed previously can be helpful. Metformin also can lower testosterone.
Wednesday September 12, 2012 7:43
7:45
If all of these fail to decrease testosterone, sometimes lupron has been used if the testosterone levels are high enough. This is certainly not natural and sometimes has to be stopped due to side effects
Wednesday September 12, 2012 7:45
7:45
[Comment From SaraSara: ]
I have tried clomid and we have done 3 cycles of iui. i have had a lot of trouble losing weight.
Wednesday September 12, 2012 7:45 Sara
7:47
Sara, weight loss is very difficult especially for patients with PCOS and insulin resistance. It requires a lot of determination, low carb and calorie restricted diet. Weight training is also helpful as it increases muscle mass and metabolism
Wednesday September 12, 2012 7:47
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[Comment From joannejoanne: ]
will a simple blood test determine the source?
Wednesday September 12, 2012 7:48 joanne
7:49
A simple blood test will not determine the source of testosterone, but measuring other androgens such as DHEAS may shed a light
Wednesday September 12, 2012 7:49
7:49
[Comment From SaraSara: ]
how many cycles of IUI are recommended before trying IVF?
Wednesday September 12, 2012 7:49 Sara
7:50
For a patient who ovulates regularly, typically 3-4 IUIs are recommended.
If a woman does not ovulate on her own, up to 6 cycles would be considered a long enough try
Wednesday September 12, 2012 7:50
7:50
[Comment From JenniferJennifer: ]
I have always been lead to beleive that 10% weight loss should help regulate. But i lost more than that at the beginning of summer and have only seemed to have more irregularities with my period. I went 3 months with a period after that
Wednesday September 12, 2012 7:50 Jennifer
7:53
Weight loss in general helps with ovulation in patients who have insulin resistnace, but as you have experienced it does not do that all of the time. It is difficult to assign a weight goal which would assure that ovulation happens regulary. The system is just too complex. There are patients who are very thin and have PCOS as well. Weight is only part of the story
Wednesday September 12, 2012 7:53
7:55
[Comment From SaraSara: ]
Can you explain what Metformin is supposed to do to help with the weigh loss and conceiving?
Wednesday September 12, 2012 7:55 Sara
7:58
Metformin improves insulin sensitivity and since insulin resistance is an important part of PCOS, it can improve insulin action. High insulin levels because of the action of insulin in our bodies lead to altered metabolism and increased rates of fat storage. By returning those levels closer to normal, weight loss is sometimes seen
Wednesday September 12, 2012 7:58
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[Comment From JenniferJennifer: ]
I was also told last year that i was vitamin D deficient by my primary and have read that vitamin D can also cause problems with infertility. Is there truth behind that?
Wednesday September 12, 2012 7:58 Jennifer
8:00
Vitamin D defficiency is very common due to our indoors lifesyles and avoidance os sun exposure. There is some effidence that Vitamin D deficiency can impair fertility, but it does not appeat to be related to ovulation or lack therof in patients with PCOS
Wednesday September 12, 2012 8:00
8:01
[Comment From JenniferJennifer: ]
Is there anything that can help with the side effects of metformin?? I can take metformin for about 3 days and then i get extremely bloated, my stomach hurts all the time, and i am constantly in the bathroom
Wednesday September 12, 2012 8:01 Jennifer
8:02
First of all you can try the extende release version. Take the dose at night and with some protein. Increase dose very gradually, some of those sideffects go away with time if you try to stick it out
Wednesday September 12, 2012 8:02
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I want to thank you all for your participation in the live chat event. I will be signing off at this time. Good night!
Wednesday September 12, 2012 8:03
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