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Trying to conceive with fertility issue
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hopefulmommy posted:
am 35 years old and been married for a year now and i've been diagnosed of thick uterine lining, hormonal imbalance, and PCOS. i undergone surgery last June 1, 2012 to remove the thick lining and took it for biopsy. the result came negative of cancer cells. my OB said i was too young to have this problem. my OB-Gyne prescribed duphaston that i've been taking regularly since the start that i visited her to regulate my mentruation. she also prescribed metformin that ive been taking 2x a day for 3 months now. she also gave me fertility drugs that i took for a couple of months (5 tablets every month) to help me ovulate but nothing happened. i went back to her and she said we will go again the same whole process as we did the first. i'm tired of taking those pills and i'm really scared that i may no longer be able to conceive. ive read from the internet that the medications im taking should only last only for six months and if not, it may cause greater risk of not having to conceive. i'm considering having a second opinion from a different OB-Gyne to ease the fear i am having right now. please help..
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Jane Harrison Hohner, RN, RNP responded:
Dear hopefulmommy: Congrats on your new marriage! It sounds like you have gone through a lot to try an conceive your first child. Let's start your questions from the top, OK?

It is very reasonable, in a woman with long term PCOS, to want to rule out abnormal/cancer cells in a too thick uterine lining--especially if one is going to start medications to increase fertility. So glad that your biopsy was without problems.

The use of the synthetic progesterone (Duphaston 10mg?) can help thin down a too thick lining, and can also be used to induce more regular flows if a woman is not ovulating regularly (eg typical for PCOS).It sounds like you were tried on clomiphene ("Clomid") to try and induce ovulations. Among women with PCOS utilizing Clomid, ovulation rates are about 75% with single babies born to 25% of those (Homburg, 2005).

The utility of metformin as a method of inducing ovulations is being debated. One hundred and fourteen women with PCOS were randomly assigned to either metformin or a placebo pill paired with a diet and exercise program. After six months there were no differences in rates of ovulation between the two groups (Ladson, 2010).

In a much larger study of 626 infertile women with PCOS, Dr. Richard Legro (2007) and fellow researchers compared metformin to Clomid to a combination of both medications for pregnancy rates. The live birth rate for metformin alone was 7.2%, 22.5% for Clomid alone, and 26.8% for the metformin plus Clomid group. Despite the increase of 4% there was no statistically significant advantage for adding metformin to Clomid.

For women who do not respond to Clomid, a surgery on the ovaries may be helpful. Laproscopic ovarian surgery (LOS) utilizes a laser or cautery device to put four to ten punctures in the ovary. About 50% of women receiving this treatment will ovulate, the remainder may need other infertility medication.

When 282 women with PCOS were randomly assigned to LOS or Clomid plus metformin, pregnancy rates after six months were similar (15-17%). Yet there were four twin pregnancies in the Clomid plus metformin group (Abu Hashim, 2010). Given that all the women in this study did not respond to Clomid initially, the take home message is that pregnancy can be achieved with the use of another treatment.

Bottom line hopefulmommy, there is no universal answer. I would consider your MD's plan to repeat the treatments as reasonable.I personally know of a 36 year old PCOS woman who conceived on Metformin Clomid.

It is also OK to seek a second opinion, if you wish. The one caveat I would share would be to take the medical advice of the person who knows your medical history---don't necessarily listen to the Internet. Each woman's case is different, and often treatments are used which are specific to an individual woman's history and needs.

Best wishes on conceiving within the next year!

In Support,
Jane
 
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hopefulmommy replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,
Thanks a lot for you info-filled reply. now, i can say that i am relieved. i'll consider your advice of following my MD who really know my medical history. Thanks again!


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