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Infertility

Not Ovulating At All Even With Stimulation

09/25/2008

Question:

I do apologize as this is quite long. I am 22 years old and have a son from a previous relationship. When I was 18, DH and I started ttc (Trying To Conceive), my 2nd child, his 1st child. After a year and not being successful, I went to my Gynecologist and he gave me clomid. I was on it for 6 cycles and Ovulated 1 time. Nov., 2007 was my last clomid cycle. In June of 2008 I went and saw a new Gynecologist and he did an ultrasound and diagnosed me with PCOS. He also started me on two months of yaz. After which he started me on a cycle of Femara 5mg. My last period was August 8th. On Cycle day 21(8/28/08) I went for a progesterone test and it came back that I did not ovulate. So he put me on 10mg provera for 10 days. I usually get my period before I finish the 10 days of pills, but this time I did not. On 9/17/08 I had another blood test done. My thyroid, which came back normal, my estrogen which was low, progeterone came back low, and a blood pregnancy test came back negative. It has now almost been another week with no sign of my period coming at all. All my Gynecologist says is that he honestly does not know what is going on, and my progesterone and estrogen levels are the same as they were on August 28th. What do you suggest and is it still possible that I could be pregnant?

Answer:

It sounds as if you are not responding to the Femara.  It is unclear as to what dose of Clomid you used (most patients who respond to Clomid will do so at doses of 150 mg {3 tabs per day} or less).  Patients with PCOS who fail to ovulate on standard doses of Clomid or Femara have a few options: 

1. Add metformin (an insulin sensitizing agent) to your treatment   

2. Use fertility shots which stimulate the ovaries directly  

3.  Proceed with ovarian diathermy (using a laser fiber to drill tiny holes into the ovary using laparoscopy where a telescope is placed through the belly button).  I would suggest that you speak with your physician regarding these options. 

With regards to your failure to have a period after taking Provera despite a negative blood pregnancy test, you may need to take an injection of progesterone to get your period started.  We have found that this sometimes works in PCOS patients when pills do not.

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Response by:

Daniel B Williams, MD Daniel B Williams, MD
Formerly:
College of Medicine
University of Cincinnati