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Infertility

Polycystic Ovary

01/13/2011

Question:

Hi,

I am 25 years old. I have been having regular periods except delayed ones (Max 10 days) if I was on a medication for fever/allergies. I have been married for 1.9 years. We were using condom for protection.

I had my period on Nov 10th. Dec 10th we tried without protection as we believed that I might be infertile on the day I expected my period. On 20th Dec, I started brownish spotting. A week later, it turned out like a normal period but only a less flow.

In the meanwhile, we met a gynecologist as the pregnancy test came negative. On scanning and blood test, the diagnosis came out to be PCOS. I have Fasting Glucose 118. The doctor advised me to take Duphaston 10Mg and Follic Acid Tablets. She also warned that I might need a medication to get pregnant.

The below are my questions, Is it necessary to take the tablets as my period has started and the fact that I have never missed a period before? Can this be somehow related to our trying without protection on the day of my next period? Will things become normal once I lose my weight (64 Kg and 5`3")? Is it possible to conceive naturally without medication?

I am so confused and we were planning to try for a baby after 3 months. I am very apprehensive of taking the tablets too early. I have never missed a period and we didn`t try for a baby properly yet. Kindly advice.

Answer:

The diagnosis of PCOS requires, at a minimum 1-persistent irregular cycles (either infrequent or absent) which signifies the lack of ovulation (anovulation) 2 evidence of an excess of androgens (male like hormones that cause hair growth, acne, etc) 3-possibly ultrasound evidence of ovaries with multiple cysts. I don't know what your work up included, but I am not clear how irregular your cycles are.

Typically cycles are 28 days apart (+/- 7 days) and are preceded by symptoms of breast tenderness, bloating, mood changes, etc that signify that you ovulated about 14 days prior.

If your cycles are further apart than that without those symptoms, then you may have anovulation. If this only happened once (Dec 20) then it is not a persistent problem. Anyway, assuming the diagnosis of PCOS is correct, pregnancy is much less likely because you aren't ovulating regularly. Often times, it takes ovarian stimulation to cause the ovary to ovulate.

If you only had one episode of an irregular period, AND all your other cycles are regular (28 days +/- 7), predicable and preceded by those premenstrual symptoms I described, you may not need to take them.

Weight loss is a great way to promote regular cycles if you currently have PCOS. As far as conceiving naturally, we don't consider the absence of a pregnancy to be abnormal until you have been trying for about 12 months, with regular cycles, and haven't been able to get pregnant. I hope this helps.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated