Q. I am having PCOS, and trying to conceive for eight months. What is the treatment?
Hello doctor, I am 33 years old. I have been trying to conceive for eight months from now. I have monthly periods and positive OPKs and BBT shifts, but periods are also very light, basically spotting. I had an Ultrasound which showed a few cysts, had mildly elevated testosterone, normal LH and FSH, normal estrogen, low progesterone. My PCP is not convinced. I have PCOS but I am wondering if that is still a possibility and what I should anticipate for treatment in the future (clomid vs. progesterone therapy, etc.)?
Hello. The fact that you are getting positive OPKs each cycle indicates that you have an anovulatory cycle or in simple terms that you are ovulating regularly. PCOD (polycystic ovarian syndrome) cannot be diagnosed alone with just small cysts in ovaries, rather one should have around 10 to 12 multiple small subcenterimetric follicles lining the periphery of the ovary during midcycle scan, one should have featyres of clinical hyperandrogenism like acne, hirsutism (excessive facial and body hair), acanthosis and most importantly oligomenorrhoea or irregular menses. Testosterone alone does not justify the diagnosis. However, if o e needs to be sure, then AMH (ante Mullerian hormone) test can be done, which is more than four indicates PCOD. As mentioned that you are on thyroid medications, I believe your TSH levels are less than five. Please share your ultrasound and hormonal profile reports for review. Now, it would also be essential to check for your partner's semen analysis for quality and quantity of sperms. I am not sure if you have any kids before or not as you have not mentioned, but if you do not yet, then semen analysis of your partner would be mandatory, as your reports are relatively normal. Progesterone deficiency can be treated, and even Clomid can be contemplated only of the male infertility factor has been ruled out first.