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High insulin, but no other signs of PCOS
cmgutmann posted:
Good day to all,

I have been TTC for about 7 months. Just went to the OBGYN for the yearly, but also to inform her of my concerns since I am TTC. She did an ultrasound and said that my uterus was looked good, but that my ovaries were not doing what they should be doing at day 13 of a regular cycle. And yes, I have normal periods. I was on birth control for 14 years, but since then I have had very normal periods except once when it came a few days early (two periods ago). I understand that being on BC can take a while to get pregnant, but now I am confused.
My OBGYN (granted this is a German OBGYN who spoke good English, but out here -- Germany -- you pay almost by the minute after a period of time) said something about the ovaries and that I am only 6mm when I should be about 12mm (can't fully remember???) and that it was caused by high insulin (her explanation: There are usually many eggs in the ovaries, and right around ovulation a few of the eggs disperse and then there is one large egg so that when it is time to ovulate, the one egg leaves, ready to be "fertilized"). I have no other signs of PCOS. I have regular periods, no unusual hair growth, and unless weight gain means more than pounds, no weight gain.
I was told by the OBGYN to eat "good" fat (i.e., Omega 3's and the like) and to lower my stress levels. I am just looking for some good information on what I should do next. Fish oils? Workout less (as I workout about 4-5 times per week either running, elliptical, or biking)? Quit my job (I wish!)?
I kept reading about PCOS but it just doesn't sound like it is what I have. I was told to come back after 6 months if I still have not conceived, but being that humans are an impatient kind, that sounds like torture! Any advice?
David K Walmer, MD, PhD responded:
You may be very astute. PCOS requires a woman to have problems ovulating. There are a number of ways to try to determine if you appear to be ovulating and sometimes one method is easier than another. I would be reluctant to make the diagnosis with a single ultrasound in a woman with regular predictable cycles. If you are having regular, predictable cycles (off birth control pills) then you may be able to detect the hormonal signal that releases the egg each month by using an ovulation predictor kit. An ovulation predictor kit that you buy in the drug store should show a positive test ~14 days before your next period. Start checking a few days early so that you can see it go from negative to positive. Alternatively, you can have a blood test for progesterone about a week before you expect your next period. It should be elevated during the 2nd half of your cycle. Either of these tests should help you figure out if the hormonal changes necessary to trigger ovulation are occurring. If either is positive then it is less likely that you have PCOS.
cmgutmann replied to David K Walmer, MD, PhD's response:
Thank you for your insight. Ironically, the only reason I started taking birth control was because my period "regularly" came a week early. I am 32, which I know is not too old in the TTC community, and am slightly confused as to why and how I now have normal periods now. I am thankful for it though -- don't get me wrong. An ovulation predictor test sounds like my next step. I normally have an abnormally low body temp (but more likely my thermometer is broken) in the morning, so that whole temp test turned me off... Alas, here is hoping!!! I guess I just needed some comforting words as I was not anticipating what my doc had said...

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