TTC w PCOS on metformin

4getmenotbride

Hello, 

Let me start @ the beginning. I had my 1st cycle @ age 11/12. It was irregular from the very beginning. The 1st period lasted roughly 4 weeks. Never has it been normal since. I mean irregular in the truest way, like completely sparatic. Some were unreasonably long, some too short, some very heavy flow, others just spotting. Also, i feel it important to mention that i have tended to spot very often over the years. sometimes spotting for long periods, also missed periods that would go for 3 to 6 to up months without anything.

 I was diagnosed with PCOS when i was about 14/15 years old. The doc told me i had cysts on my ovaries and when i was older & TTC that i would need fertility medicine. @ age 14/15 i wasn't heartbroken about this news. I thought when the time came it would be simple enough. Well, the time is here. I am 25 years old & married. I am lucky in that my husband could go wither way on having children, but for me...it is important.

I was on birth control for a couple years thru high school. After age 18 i'm afraid i have let my PCOS go untreated. So, @ age 24 i decided to go the doctor. I explained myself & was put on metformin 500 mg to start. Gradually i was able to have my dose upped until i reached my current dose of 1500 mg daily. With the initial dose of 500 mg i had spotting. (which was a huge deal to me) I hadn't had any blood whatsoever in at least 3 seasons, if not longer. I started the 500 in January of 2014. It is now almost September of 2014 & i still have blood but its light & lasts around 2 weeks-ish. (not exactly sure). 

I had the doctor do a hemoglobin back in may (when i started the 1500mg dose) & my value was 5.6 also my estrogen progesterone and testosterone were tested in may. (i do not know where i was in my irregular cycle)

estrogen: 181

progesterone: 1.2

testosterone:113

testosterone free:2.1

So, my testosterone is high. which makes since bc i do have an issue with excessive hair growth. So, i have rambled one....

point is i have seen some progress, but im not regular. i want to be regular, and i want to conceive. I am terrified of not being able to have a family.

And noone that i know understands. They can all just get pregnant any old time they want. And i need someone to talk to that understands, and also some pointers or advice. Thanks.

shirleymaeby

Hey there, how long have you been TTC?  Have you considered seeing an RE to help you out?

4getmenotbride

Roughly trying for a year. RE?

LindseyM2012

It sounds like your PCOS is similar to mine (multiple small ovarian cysts; high testosterone - mine was 114 at last check). Treatment-as-usual when TTC is Metformin paired with Clomid or Letrozole.  Since PCOS is a syndrome, there isn't a true "cure" for it; a person can just manage the cluster of symptoms that make up PCOS, which usually includes BCPs to balance out high testosterone and reduce the ovarian cysts.

I would talk to your doctor about the best form of management for your particular case. Unfortunately, unmanaged PCOS (i.e. no regular bleeding/shedding of uterine lining) can put you at an increased risk for uterine cancer. Being on Metformin can help manage any insulin resistance you may have that can go along with PCOS (are you insulin resistant - I don't think you mentioned), but doesn't fully target the hormone imbalance when TTC and when you're not TTC. My plan for TTC is Metformin and Letrozole (with monitoring).  When not TTC, I will be on BCPs to balance hormones.

I hope this is helpful. Also, I'd suggest seeing an RE if you're not already. PCOS is an endocrine disorder in which an RE will be VERY well versed.  An ob/gyn will probably have some knowledge of the ins-and-outs of PCOS but won't have the expertise for treatment/management.

LindseyM2012

4getmenotbride said:

Roughly trying for a year. RE?

Reproductive endocrinologist. They specialize in getting you pregnant when there are issues whereas an ob/gyn specializes in keeping you pregnant after you've already conceived.

shirleymaeby

A Reproductive Endocrinologist.  Everyone on the board will tell you that if you have been TTC for at least a year with no luck you should see an RE.  You can either talk to your OB about getting a referral or you can just google REs in your area and call to make an appointment (that's how I got in to see mine).  An RE will run a battery of tests on you and order a semen analysis for your husband.  Once they have a clear understanding of your specific fertility issues they can help you come up with a treatment plan.

Some ladies try to get help from their OB first but what I have found is that OBs just don't know how to get you pregnant (but they can keep you pregnant once you get there).  I wasted two years working with an OB before I finally got a referral to an RE and it has made a huge difference for me.  So working with an RE is really your best course of action.

Good luck to you! 

BunnyBerry

Welcome to 3T! Sorry for all the struggles you've been through with your cycle.

Metformin is a start but not a one-stop miracle drug to help you get pregnant. If you haven't had a period in a long time (40 or 45 days I believe?) it's typical to take a med to bring it on. Also, you'll probably need an oral med like Clomid or Femara to help you ovulate.

Before using fertility meds, you'll need to make sure that there are no other obstructions to getting pregnant. That means a hysterosalpingogram (HSG) to make sure your tubes and uterus are clear, two sperm analyses (SA) for your husband to see if there is any male factor IF, and then follow up treatment for anything they find. A reproductive endocrinologist is the person to see for all this, as they can look at your entire hormone and bloodwork panel to make the best treatment plan. 

For women with such irregularity and/or anovulation, it's recommended to see an RE even before the one year mark, so you can certainly feel justified to take that step if you feel you are ready.

4getmenotbride

Thank all of you ladies for your advice. That was definitely alot of help. On my next visit i am going to ask to be referred to an RE.