If you have PCOS and are not responding to clomid, FSH (follicle stimulating hormone) is one of the next options.
Say you are in your late thirties and have been diagnosed with PCOS but you have regular menstrual cycles. By most definitions, you can’t have PCOS unless your cycles are irregular. There are some groups who say that you can have PCOS even if you have regular cycles, however most doctors feel part of the definition of PCOS should include menstrual abnormalities.
It is not necessary to measure the LH (lutenizing hormone) level in women with PCOS. The combination of Irregular cycles, along with many follicles visible on ultrasound are all that’s necessary to make the diagnosis. Other tests may be necessary to rule out diabetes or other metabolic disturbances, and sometimes we check for adrenal problems, but most of us no longer measure the LH, or the ration of LH to FSH.
For women who have PCOS that are not getting pregnant on clomid. Should you keep trying on your own? Well if you are not getting pregnant, eventually you need to change the plan. In general, clomid is used for about 3 tries, but in the case of PCO and anovulation, more tries are considered acceptable if the clomid does in fact help the woman to ovulate. This is because clomid levels the playing field. Someone who does not ovulate on her own, but does so on clomid, has about the same pregnancy rate as a normally ovulating woman, so why panic after 3 months? However, giving clomid to a normally ovulating woman is not always as successful, so switching to injections or IVF after 3 months is the typically accepted time frame.
As an aside, no matter what your age, If based on your BMI (body mass index) you are in the obesity range you need to seriously lose weight regardless of your fertility issues. Being pregnant when you are significantly overweight is not safe for you or for your baby. If you lose weight you may start to ovulate regularly. I know this is all easier said than done, but you need to seriously look at all of your options including medical and surgical approaches.
Next steps: if you have not become pregnant after a number of cycles of clomid and then injection cycles, IVF is the next step. Of course, you can continue with iui if you wish, but you need to talk to your doctor about the options and success rates of each.
To learn more about PCOS and medications that may help, click here
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