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Suffering From PCOS With Hirusturism And Cystic Acne, Under Ttc. Treatment?
Hi! I have pcos with pretty severe hirsturism and cystic acne. I have elevated testosterone and low progesterone. I have tried clomid, but still didn't ovulate and developed cysts and my right ovary grew to 3x normal size. We are ttc, for the last 3 years, with no success. My dr. Is now suggesting wedge resection. I am wondering if there is any way to treat my hirsturism and acne while ttc. Thank you!
Mon, 13 May 2013
Hello and welcome to HCM.
Thank you for your query.
First of all, let me tell you that the first line of treatment for a woman with PCOS trying to conceive is the drug clomiphene citrate. Now, for majority of women, this drug seems to do the job, but we have encountered many cases in which this is not the case. Let us shed light on why this happens.
First of all, most of the cases not showing a response to clomiphene is due to an inappropriate dose (too low). Clomid is started off with a 50 mg dose, then raised to 100 mg, if the patient does not respond to a dosage of 50 mg. At times, a dose of 250 mg is even given. And if no response is seen, then a diagnosis of 'clomiphene resistance' is made.
The reasons for climiphene resistance are:
-Insulin resistance
-High levels of male hormone levels and/or DHEAS (you have mentioned high testosterone levels; this needs controlling at the earliest, and could very well be the main cause to your non-responsive state)
-Obesity (a BMI of above 25), need to lose weight
-High levels of prolactin
If obesity- reduce weight, if high prolactin- medical therapy with bromocriptine, if high male hormones or DHEAS-medical and physical therapy, if other causes-medical therapy with metformin.
Even after this, if clomiphene is still not working then the doctor should consider options like treatment with birth control pills for 2-3 months, and then back to clomiphene or with drugs like ovidrel, letrozole, etc.
Please discuss all options with your doctor.
I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications. I would gladly help you.
Best wishes.
Thank you for your query.
First of all, let me tell you that the first line of treatment for a woman with PCOS trying to conceive is the drug clomiphene citrate. Now, for majority of women, this drug seems to do the job, but we have encountered many cases in which this is not the case. Let us shed light on why this happens.
First of all, most of the cases not showing a response to clomiphene is due to an inappropriate dose (too low). Clomid is started off with a 50 mg dose, then raised to 100 mg, if the patient does not respond to a dosage of 50 mg. At times, a dose of 250 mg is even given. And if no response is seen, then a diagnosis of 'clomiphene resistance' is made.
The reasons for climiphene resistance are:
-Insulin resistance
-High levels of male hormone levels and/or DHEAS (you have mentioned high testosterone levels; this needs controlling at the earliest, and could very well be the main cause to your non-responsive state)
-Obesity (a BMI of above 25), need to lose weight
-High levels of prolactin
If obesity- reduce weight, if high prolactin- medical therapy with bromocriptine, if high male hormones or DHEAS-medical and physical therapy, if other causes-medical therapy with metformin.
Even after this, if clomiphene is still not working then the doctor should consider options like treatment with birth control pills for 2-3 months, and then back to clomiphene or with drugs like ovidrel, letrozole, etc.
Please discuss all options with your doctor.
I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications. I would gladly help you.
Best wishes.
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