Sir my wife has a high thyroid and prolactin levels from 2 years, although in control with thyroxin - 50 mg and proctinal - 1.25 mg.
Recently she didnt had periods for 2 months with all levels in control. We got followin tests done -
1. Ultra-sound of uterus - revealed possiblty of PCOS as follicles not maturing.
2. Body profile checks of platelett count, haemoglobin etc which were normal.
3. Brain MRI(regular headaches) and bone densitometry(for joint pains) which were normal.
4. Day 3 FSH-6.2 and LH-11.4.(she had been taking ginette for 21 days after previous periods)
5. internal scan of uterus which again revealed PCOS.
Currently her gynae has asked to get a HSG done and take progesterone tablets from day 21 of her cycle.
Please suggest whether we are on the right prescriptions and why is she not ovulating even when FSH and LH are correct. Also do we need to get E2 or any other test done.
Also if u may, do write about the path to be taken to concieve and plan a family.
Hello Abhimanyu from India,
By definition, your wife meets the criteria for the diagnosis of PCOD (Polycystic ovarian disease). The criteria that makes this diagnosis in your wife are: irregular periods/ovarian dysfunction, PCO-type ovaries on ultrasound and an elevated LH/FSH ratio (LH is 2X or more higher than FSH). PCOD is one of the most common reasons for difficult getting pregnant. I have written extensively regarding this diagnosis and the problems and treatments in my BLOG, cited below. I would strongly recommend that you refer to it.
The problem with PCOD is NOT a problem with cysts, but it is an ovarian or ovulatory dysfunction. This is where ovulation, or giving off an egg, does not occur and as a result there is not egg to fertilize and create a pregnancy. There is no cure for PCOD, but in order to facilitate pregnancy, we use fertility drugs to stimulate the ovaries to ovulate (that's what all fertility drugs do).
Certainly, you can continue to complete an infertility evaluation as your doctor has prescribed to make sure there are no other problems present. The treatment recommendation will then be based on what problems are found. If no other problems are found, then the treatment of choice to achieve pregnancy would be ovulation induction with either timed intercourse or IUI. Drugs used for ovulation induction include Clomiphene, Letrozole and injectable gonadotropins. Most PCOD patients will not respond to low dose clomiphene or letrozole so will have to try the high dose first, then move on to the injectables. In order to NOT waste your time, I would make sure you see a doctor that is an infertility specialist and is well versed on PCOD patients and treatment. General Ob/Gyn doctors don't seem to have a good grasp of this problem and just prescribe medications without close surveillance of the patient's response.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com
check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.