polycystic ovaries--next steps?

[Anonymous]

I am 31 and ttc #1. I recently went in for day 3 bloodwork and ultrasound at SG. Truthfully I wasn't expecting to receive any information on the spot and having had a normal ultrasound less than a year ago I wasn't prepared to see anything abnormal. When the doctor came in he said that my ovaries have a polycystic appearance (20 follicles on one ovary, 25 follicles on the other ovary). He said that this doesn't necessarily mean that I have pcos since I don't have any of the other symptoms. Since going off of birth control my periods have been very regular and I have seen a surge on opk's for the past several months. This month I never saw a surge and my period came later and lighter than usual.

The doctor said I could come in for monitoring or use opk's, "whatever you want" but may need to use clomid. He was very matter of fact about the appearance of my ovaries and said "you'll be fine" before exiting the room. I am now left feeling very worried and unsure about what to do next. I received normal bloodwork results and have exchanged messages with my nurse about the ultrasound. Prior to the appointment we were planning to do a natural cycle IUI (my husband's SA was fine) but I am not sure how the doctor can expect me to make a decision without more information. I plan to consult with my nurse and get more info.

For women with pcos, please share any advice or protocol for conceiving. Also is it possible that the ultrasound that I had less than a year ago looked normal b/c I was on birth control?

[Anonymous]

I'm 29 and have pcos. I was diagnosed by my gyn and given almost no information from her about what it meant just that I needed clomid. Like you, I was confused. I'd been on bc since I was 15 and the first 3 cycles after stopping bc I had regular cycles then a very long cycle that lead me to visit my gyn, who did an u/s and determined I had pcos. To answer your question, yes, your ovaries would likely look normal on bc because the bc controls most of the symptoms of pcos. Most people associate pcos with being overweight, but there are actually several types of pcos. I do have mild acne, which is a side effect of pcos but didn't really know how bad it was until I was off bc for a while. I also got the pleasant side effect of some facial hair, but it's really just a few dark hairs on my chin I didn't have before and I get one or two more every couple of weeks, the longer I'm off bc.

Clomid should be the next step for you. It helps a lot of people with pcos. You should do a clomid challenge test, which I imagine SG will have you do. I didn't know any better and did 3 unmonitored cycles with my gyn where she just put me on clomid and told me good luck. SG will put you on clomid and watch you closely to see how you respond. You might still get multiple follicles, but with clomid hopefully a few actually mature. You may or may not need to trigger ovulation with an injection. For me I didn't really respond to the clomid so this next cycle I'm starting injectibles.

As far as advice goes, I find charting helpful and use fertilityfriend.com, but OPKs are a waste of money imo, especially with pcos. I got a lot of false positives. The best thing you can do, even if on clomid, is have sex every other day from about the time your period stops until it starts again. It can sound like a lot, but you really don't know when you'll ovulate. Even on clomid, I was ovulating late in my cycle. If you end up using a trigger shot, you can just go for the specific window your doctor gives you.

Hope that helps, happy to answer any other questions.

[Anonymous]

I have a similar story, but did not ovulate on my own. I also went to SG for testing not expecting to hear anything was actually wrong. It was jarring to not get much info from them and have them just give me a couple of papers about clomid and send me on my way. I went to Dr. Sacks at Columbia, who I found to be more willing to discuss things, answer questions and explain options.

[Anonymous]

00:15 here, I also go to Dr. Sacks, haven't been to SG though. Dr. Sacks explained things some and then put me on clomid. He was quick to identify me as a non-responder though and move me to injectibles.

[Anonymous]

I see Dr. Rifka at CFA and had a similar experience as the PP. Tried Clomid, which didn't work at all for me and then moved on to IUI with injectibles. I got pregnant from my first IUI with my oldest child. Now pregnant with #2, but it was a lot harder this time around (I'm older and my husband's IF issues have worsened over the past couple of years). I also have PCOS-like ovaries on ultrasound, but don't exhibit many of the physical symptoms.