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Ask Dr. Norm S. Your Own Question
Dr. Norm S.
Dr. Norm S., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 11231
Experience:  Over 30 years of experience in OB/GYN practice, including teaching students. Fellow of American Board of Obstetrics and Gynecology.
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I am 30 years old and my husband and I have been

Resolved Question:

Hello,
I am 30 years old and my husband and I have been trying to conceive our second baby for the last 3 years. I have had PCOS since I was 15. I conceived my first child almost 5 years ago. I weighed 50kg at that time. After the pregnancy I've struggled to lose weight and at the moment I am 66kg.
I've been prescribed Clomid and have been taking it since last year but with little success in ovulation or periods. In June, the dosage was increased to 150mg to help me ovulate.
Since June, according to ClearBlue home ovulation test kit, I have ovulated each month (roughly every 28 days) but have not got a period. Last ovulation was a week ago. My doctor refuses to accept that I have ovulated (despite having a positive ovulation test for 3 consecutive months through the test kit) as according to the doctor it is impossible to ovulate and not have a period. I have checked and I'm not pregnant.
Can you please help?
Submitted: 1 year ago.
Category: OB GYN
Expert:  Dr. Norm S. replied 1 year ago.
Hello and welcome.
I am Dr. Norm, and I look forward to helping you today.

Since you've been trying for 3 years, I think it's time to see a fertility specialist and move on to stronger medication to help you to ovulate.

I agree with your doctor that ovulation seems very unlikely. The ovulation kit checks for the LH surge, and it's possible to have a surge but have no ovulation.

If there is a question, then drawing a blood progesterone test 1 week before an expected period (about 2-3 weeks after the last Clomid pill) will tell you, since a low progesterone means no ovulation. If you had ovulated, you should have gotten a period.

Most things we do to help women with fertility problems are generally tried for 3-4 months, and if they aren't working, we move on to something more, since the likelihood of success after 3-4 months goes down and down.

There are stronger medication that will help you to ovulate. Possibly a higher dose of Clomid might do it, but there is generally no reason to be taking Clomid for longer than about 6 months, and then move on to something stronger. Best wishes.
Customer: replied 1 year ago.

Thank you Dr. Norm for your answer.

What other treatments do you think could be suitable in my situation? I'm in the UK and I'm told the maximum dosage for Clomid is 150mg so I don't think they'll increase the dosage.

Expert:  Dr. Norm S. replied 1 year ago.
The maximum dose of Clomid is 200mg, but if 150mg doesn't work, 200mg is not likely to work either.Metformin is often used in PCOS, and sometimes adding metformin will help Clomid to work better.Otherwise, gonadotropins are used, which will cause any woman to ovulate if she has working ovaries. They are generally only used by fertility specialists.
Customer: replied 1 year ago.

I've been taking metformin 3x500mg since I was diagnosed with PCOS 15 years ago. So far, it hasn't helped me in conceiving my second child. I was able to conceive my first within 3 months of trying. But I had regular 40 day cycle and weight 50kg as mentioned.

I'm inclined to believe that the complications are aided by my weight gain.

I have an appointment with my gynaecologist tomorrow so I will discuss gonadotropins as an option with them. Thank you for your help!

Expert:  Dr. Norm S. replied 1 year ago.
Weight loss can help enormously in PCOS, but weight loss can be difficult, as you know.For some women with PCOS, losing weight will cause them to start ovulating spontaneously, and will help Clomid to work better.
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