Dr Ramirez on PCOS and IUI/IVF
Oct 3 2011 in Ask the Experts, PCOS by Dr. Edward Ramirez,
Cryshouse Asks:
I have been diagnosed with PCOS. Subsequent to my diagnosis, I went through ovarian drilling at the suggestion if my Dr. Three months after surgery, I got pregnant on 50mg of clomid but lost the pregnancy at 10 weeks. Other rounds of clomid were unsuccessful.
That miscarriage was a year and a half ago. I have a new doctor who has suggested iui. Since later rounds of clomid didn’t work, should I even be hopeful that iui could be successful? Or could the ovarian drilling have negative effects over a period of time?
Dr Ramirez Answers:
The main disorder with PCO is that the ovary does not function correctly and
therefore ovulation does not occur leading to a hormonal imbalance. Clomid,
as well as other fertility medications, induce ovulation in the ovaries.
With ovulation you give off an egg and if all the other steps required for
pregnancy work, you get pregnant. That is what happened in the first cycle.
IUI is not that much different than Clomid with intercourse except for the
fact that the sperm is injected directly into the uterus and flows into the
tubes where it need to meet the egg. Pregnancy rates are slightly
increased, however but this is due to getting the ovary to ovulate more than
one egg, getting the sperm where it needs to be and timing it better. In
traditional fertility treatments, the treatment levels are ovulation
induction with intercourse, followed by ovulation induction with
insemination followed by IVF.
Since you have been failing Clomid with
intercourse, then it is time to move to the next step. In some patients
this will be IUI. I take all factors into consideration when making this
decision and that includes age. If you are over 36 years old, then I would
strongly recommend IVF because of an inherent debilitation of the egg with
age. If you are younger then IUI is acceptable.
Keep in mind that these recommendations assume that there are no other
problems except for PCO. If there are any other problems, or a full
evaluation has not been done since your last pregnancy, then everything is
changed. The treatment has to treat all the problems for it to work.
Good luck,
Edward J. Ramirez, M.D., FACOG
jasmin said on May 4, 2012
hi doctor I was wondering if you could help me. My doctor said i may have mild PCOS. But i don’t know if it is pcos or just DHT sensitivity, as I do not suffer weight gain or excess hair, and i have been pregnant before when i was 18. I have been off yasmin, (which ive been on for about 9 years) for 18 months whilst trying to get pregnant and in this time I have lost a lot of hair gradually from my hairline receding back an inch and have terrible acne, greasy hair that has gone very fine and delicate. I feel so ugly and disgusting because on yasmin i was always healthy and glowing and lovely thick hair. We found out my husband has low motility and we cannot conceive naturally. so we have to go through icsi. Since we found out, i went back on yasmin because i was losing the will to live and have been back on it for nearly 4 months. safe to say my skin is now great and glowing again, my hair, although it hasnt grown back, is now thicker feeling and not greasy and I feel happy in myself mentally again. I guess i want to ask you, if i go off yasmin again to receive this treatment and hopefully get pregnant, will my hair start to fall out again and my acne come back? or the extra estrogen from pregnancy cause everything to stabilise? thanks so much for taking the time to read this, my gp doesn’t really care.