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Thread: PCOS or not

  1. #1
    Join Date
    Apr 2012

    Default PCOS or not

    Seems like it is rather difficult to get a confirmed diagnosis of PCOS. I have a lot of the symptoms, but not all. I am not overweight, don't have acne, are the main ones. but I do have chronic annovulation, seem to be infertile. I do have endometriosis as well. so do I have PCOS???

  2. #2
    Join Date
    Oct 2008

    Default Not always straightforward

    Many women experience ovulatory disturbances that are presentwith PCOS, but they don't have ALL the problems that we typically associate with classic PCOS. There are several physiologic disturbances that are seen with PCOS, and the underlying cause of those disturbances is not understood. There can actually be many "causes" of PCOS, as this syndrome is a state that many women reach due to that underlying unknown problem.

    It is a spectrum of disturbances. Some women have irregular menses with polycystic appearing ovaries, but no hormonal side effects such as hirsutism or measureable elevations in testosterone. Some women have regular periods, but may experience fertility difficulties. Not all women are overweight--PCOS does not cause weight, but when some women gain weight, there is a biochemical imbalance that can trigger the ovulatory problems seen with PCOS. As we are in general an overweight society, especially many young women, PCOS is seen frequently.

    We have established criteria to "diagnose" PCOS, but the diagnosis really is simply academic, as we never know the true cause of PCOS--but we are pretty good at treating the symptoms that result from the underlying biochemical disturbance. But to have a "diagnosis" of PCOs, one needs: 2 of 3 symptoms:
    1. Irregular periods or some ovulatory irregularity
    2. Evidence of unwanted hairgrowth OR measurable elevations of testosterone (even without hair growth)
    3. Polycystic appearing ovaries on ultrasound (>12 small visible follicles on each ovary).

    That is all it takes to get the diagnosis of PCOS. So for you, you have chronic anovulation (one symptom). If your ovaries appear polycystic, then you have the "syndrome", regardlessof whether you have acne orunwantedhair growth. Both of those symptoms are due to elevations in testosterone levels, which may have been measured. But you don't HAVE to have all symptoms. But I will see many women with regular periods, polycystic appearing ovaries, no hirsutism, but infertility. Is the infertility an ovulatory disturbance? It is hard to know. A woman can undergo the hormonal changes associated with ovulation, and even have a normal period, but that does not mean everything functioned perfectly during the ovualtion process.

    So I hope this answers your question somewhat. Regardless of the diagnosis, we treat the problems: if you are trying to conceive, we ensure ovualtion is taking place; if you are having irregular periods, we can control that easily with hormones (birth control pills or other); and if hair growth is the problem, we TRY to address that hormonally as well as physically, but we are not very good at changing hair growth patterns unfortunately. But for you, that is not a problem!

  3. #3
    Join Date
    Apr 2012

    Default Great Feedback another question

    Thanks for the awesome feedback!!!
    If one has endometriosis, chronic annovulation, hypothyroidism, has been trying for 2.5 years to get pregnant but hasn't been avoiding pregnancy for 7 + years and has done the following
    3 cycles of just femara
    3 cycles of femara, hcg, and IUI
    2 cycles of femara, bravelle, or gonal-f, hcg and IUI and still doesn't get prego
    TSH was high 3.99 and now 1.4 after meds
    FSH 3.4
    E2 64
    AMH 4.4

    HSG showed tubes open and no problems
    Had laproscopy done and endometriosis was removed with no ashersmans syndrome.....What would you recommend next or what has been missed?

    Husbands kruger score is 12%??????
    I don't ovulate on my own without HCG shot.

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