I was told that I didn't have PCOS because I'm thin and don't have the acne/male-related characteristics, have my period (33-35 day cycle), and ovulate monthly (confirmed via temping). Lo and behold, I have an AFC of 38 with the infamous "string of pearls" and high (18) AMH. Doctor now says I may have mild PCOS. I was anovulatory in college, but chalked it up to stress. Menstruated fine before that and then later on though. Age 34, no kids yet. Day 3 LH is 10, LH to FSH ratio s 1.3, so under the 2+ range that is indicative of PCOS.

So now I'm reading all about mild/lean PCOS, and metformin keeps popping up. Some people say that it's a must to prevent miscarriage/boost egg quality, others seem to prescribe a "wait and see." It seems to be most common for traditional PCOS symptoms, less so for mild/questionable cases, especially for those who ovulate on their own--but then some people still say that it's important. Not sure what to make of all of it. I don't think I'm insulin resistant--although I guess I could be even though I don't have the accompanying weight gain. I'd say I'm blood sugar sensitive if I don't eat...but doesn't everyone get hangry once in awhile?

Any insights/experiences with metformin from people with "mild" PCOS--whether it's needed or not--would be very appreciated. Shady Grove didn't mention it at all, so I'm not sure if I'd have to push them to put me on it. Should I be doing additional testing with an endocrinologist? It seems like the treatment protocol (Clomid, IUIs, then IVF eventually) is pretty much the same regardless. Is it worth seeing if I have insulin resistance (and if I am, then should I consider metformin more?)? Should I get my testosterone (or anything else) tested to see if I have more PCOS symptoms? (And would that change anything if the proposed treatment is pretty much the same?)

Any other tips for navigating ART (IUI or IVF) from folks with similar profiles would be appreciated. So far this is really the only thing on my end. We are just starting IUI. Everything else looks fine other than DH's morph is 3%. Gracias.

Thanks everyone for sharing your experiences and so glad to hear of successful IVFs!--15:52, with Shared Risk I thought that you could withdraw at any time and get the $ back? (Although it'd certainly be a hassle, esp if you have frozens there) Also, 15:52, did insurance count that as 3 separate cycles, or 2? (As in, did it count the "freeze all" as a separate cycle from the failed FET, even though nothing was transferred for the freeze all?)

MD maxes you out at 3 cycles, but it's unclear if they 1) cover FETs (seems like you have to petition) and 2) whether the FET counts as a cycle, or if they just count the cost towards the lifetime cap (which would be great). I believe they do count FET as a cycle/attempt. Just don't want to get maxed out in case we needed more tries/FETs--hence, the openness to shared risk. (Have Carefirst BCBS through the State)

Hi, I am 34 and we've started seeing Dr. Levens at Shady Grove. I like him a lot but have also heard the common critiques of SG feeling like a factory and them not being open to thinking outside the box. We have yet to do anything beyond testing. So far the two concerns are DH's morphology (3%, they didn't seem too concerned since the other #s are good, but it's still low) and having high AMH (18.7 ng/mL). I guess the high AMH is a concern not just for OHSS risk, but also acc to this article by Geoffrey Sher, "However, both high and poor responders have one characteristic in common, namely that in both cases, there is a high tendency for their eggs to be chromosomally abnormal (aneuploid), which leads to embryos that cannot develop into a “normal” baby." (http://haveababy.com/fertility-information/ivf-authority/ovarian-stimulation-what-high-responders-and-poor-responders-have-in-common) Sigh.

Dr. L seems pretty confident that I don't have PCOS and I don't have symptoms (ovulate regularly, 33 day cycles generally), normal weight, etc., so I'm guessing I'm in the potential high responder-but-no-PCOS camp. Any insight from folks on 1) Whether we should spend time on Clomid (which he already suggested)/IUIs, or limit time there and go on to IVF? (also b/c of the morphology issue) 2) If you have any experience as a high responder without PCOS and how that affected your IVF experience 3) Whether this situation seems within the realm of things that SG is equipped to deal with (impossible to predict, but any insights are appreciated), or if there are other recs.

(Sidenote, spoke with Dr. L again and he's unconcerned about the high AMH and says it shouldn't affect things other than tweaking an IVF protocol to take into account being a high responder. But 18.7 just seems incredibly high! And in a "there must be something weird/wrong" way, not a "wow, sounds great" way. I still do have to do my AFC, so that will give some more info.)

We have great insurance (thank you state of MD), but I was thinking we might do Shared Risk b/c the cost of FET's could potentially add up, and then we have the insurance to fall back on if we need to see someone else in the area that's covered.

All hypotheticals, but it's nice to throw our situation out there in a pool of people who have gone through this and see what people might know.