LTTTC#1 with PCOS, taking Metformin, and not always ovulating

[Fizzyfefe]

I was just wondering if anyone was in a similar situation and can relate to what I'm going through. I need some support, as I don't have anyone in real life that I can talk to about this.

I was an avid poster in TTC for quite a while, but after hitting the one-year TTC mark, I got very angry and didn't really want to post anymore. I still don't post like I used to, because I don't feel like a lot of people understand. I feel like everyone else is getting pregnant, or doesn't have the same medical issues that I do.

I was only recently diagnosed with PCOS, after undergoing a laparoscopy to rule out endometriosis. My ovaries were so swollen with cysts that they were larger than my uterus, and the doctor performed ovarian drilling on both sides. She prescribed Metformin, which I have been taking for a month. Due to her leaving the practice, I had an appointment with a new ObGyn today. She prescribed Metformin for another few months, told me to start OPKs again, and said I need to give it between 3 - 6 more months to work. If it doesn't work by then, she said she will refer me to a reproductive endocrinologist. I hope it won't get to that point, because hubby's insurance does not cover anything related to infertility.

Honestly, I am terrified that it will not work. Going off all my past charts, I don't think I've ever ovulated since getting off birth control in December of '11. I don't get fertile mucus, never get a clear thermal shift, and bleed irregularly all the time. Most days, I have very intense pain in both ovaries. I've also never had a truly positive OPK.

Overall, I feel very angry and depressed about my situation. It's gotten to the point where I can't even go out into public and look at a pregnant woman without getting upset. I don't like to go out, I don't have any friends since moving with my hubby to Arizona, and I'm basically just a miserable person who sits in the house all day. If we're being completely honest, I hate the person I've become.

Hope to make a buddy who is going through something similar to this.

 

[pinksprinkles]

I totally feel for you hun. This whole LTTTC thing has gotten me pretty down, too. I was feeling about as bad as you're describing until they got me ovulating again a few months ago. Of course, it's still terribly hard, but I feel like my medications have at least got my energy level back to almost normal.

If I were you, I'd go ahead and head to an RE now. My insurance doesn't cover infertility, but they do cover anovulation treatment, and I think that is how most insurance plans are. I've got insurance coverage at my RE because all we're doing are monitored and medicated cycles- and that gets submitted as anovulation treatment, not infertility. You just have to make sure they're using the same coding that your current OB/Gyn uses.

My DH and I are doing our own IUI's at home starting this cycle. As long as insurance doesn't know about them, they won't stop paying for everything else. It's great because it means an entire monitored/medicated/triggered IUI cycle is only $700 instead of the $2500 it would be if the RE did the IUI. Plus, it's slightly more intimate having DH do the IUI. I have not been able to get comfortble with having a doctor be the inseminator. Just too weird. (Of course, if we do several IUI cycles and it doesn't work, well, we'll have to move on to IVF, and there's no options about who does that!)

As far as meds go, I'm currently on Metformin for my PCOS/Insulin Resistance and I was just switched to Femara from Clomid. Clomid can really mess up your uterine lining and cervical mucus and it can give really bad side effects, so I don't recommend it, especially if you already have CM issues. I'm on day 2 of Femara now and so far no side effects. The lining and CM issues don't happen with Femara. Then once I have some nice follies, I'm getting the hCG trigger. They did it last month and boy did I get some hot flashes!

Anyway, I highly recommend going to an RE. They can do the testing, medicating, and u/s monitoring that most OB/Gyn's refuse to do (and that in your case, you really need).

GL hunny! Feel free to message me anytime!

 

[Fizzyfefe]

Hi, Pink. Thank you very much for your response. I remember you from the TTC boards, and I have read a few of your posts on the LTTTC board. It's great to hear that you are ovulating again.

My doctor didn't want to prescribe Clomid yet, because the side effects (that you describe) can be dangerous. She wants to try the Metformin for at least two more cycles, but I just can't understand why. I am not insulin resistant and have no issues with blood glucose levels. But, I guess it's the safest drug, so she wants to stick with that for now.

I honestly believe that if I was ovulating, then I would feel so much better, because at least I would have a chance of getting pregnant. Without ovulation, though, there's just no chance whatsoever, and it kills me. I can deal with the terrible cramps and PMS and bloating and ovulation pain, if there could just be an egg released at the end of all of it. But it's like I have to go through all the notions without a reward at the end, you know? Add in the continuous bleeding/spotting, and it's just like kicking me when I'm already on the floor.

So you suggest that I see an RE sooner rather than later? My current ObGyn is pretty confident that it will work within six months, but I don't know. I just have that gut feeling that it isn't going to work, and it will just be more wasted time. (My gut feelings about my health almost always are right.)

 

[Chels.Milne]

Awe, I totally understand where you're coming from. This whole process is hard enough, without the added frustration of broken ovaries that refuse to ovulate.

I have PCOS as well, and my husband and I have been trying for #1 for 2 years now. I won't give you the long, boring story - but we've done several rounds of Clomid, Femara, injectables and 4 IUIs - none of which has resulted in a pregnancy.

I finally brought up Metformin with my RE, as I had heard it helped with PCOS symptoms - and my doctor prescribed 1500mg. The second month on Metfomrin, I did the digital ovulation pee sticks just for the hell of it, and ended up getting a positive. I was nervous it may have been a PCOS false positive (as if PCOS weren't annoying enough) - but my period showed up two weeks later. The next month I got another positive, and I asked to get a progesterone test, because I wanted to confirm I was ACTUALLY ovulating - and suuure enough, I was. That said, however, I'm currently on CD 65 because I apparently didn't ovulate this time. Sooo, I don't know if Metformin is just losing it's charm, or what's going on. I'm on Provera to induce another period now - such a pain. We have an IVF consult next week - even though our insurance doesn't cover a NICKEL of it. So that will be fun trying to convince my husband it's worth the 10 grand.

Anyways, I totally know how you feel - it's so frustrating when your body doesn't do what it's supposed to. Give the Metformin a few more months - it will help to regulate your hormones, and hopefully that will help get you on the right track. It's hard to stay strong, when you don't have people to lean on - but that's what the internet is for, eh? Good luck!

 

[pinksprinkles]

I do think going to an RE is the best choice. Not that standard OB/Gyn's aren't good doctors, but they are not as specialized or as educated on infertility as RE's are. I tried several OB/Gyn's at our local women's clinic before switching over to my RE and with the OB/Gyn's I just had a really bad experience. They refused to do routine mid-cycle ultrasounds, refused to try anything besides Clomid. They only did the testing they did (HSG, u/s, BW) because I specifically told them I would not take Clomid without proper testing first and I demanded the tests be done. They acted like I was being ridiculous, but did submit the forms to have the tests done. The whole situation was time consuming and infuriating.

As soon as I switched to my RE, which I did on my own without a referral, things immediately got so much better. I finally got all my testing done, and I got intensive treatment, which is what I wanted. Since my insurance does cover anovulation treatment, I could think of no reason not to get the best care available with the most monitoring available. Right now a standard cycle goes: CD2 baseline u/s, CD3-7 meds, CD12 u/s, CD14-ish u/s, and then whether or not I have good follicles I get either an hCH trigger or another round of meds. If I get the trigger, then I do a CD21 progesterone draw just to make sure everything worked fine. If I do another round of meds then I do more u/s's after the meds are done, if there are follicles I do the trigger and the a week later, progesterone draw. I have not had a cycle where I haven't O'd after the second round of meds, so I'm not sure what they would do then, but I do know they would do something!

It definitely is a lot more than with my previous OB/Gyn's, but that's what I wanted. With the last clinic all I got was a baseline u/s and some Clomid. At day 21 I was supposed to get a progesterone blood draw and if it was negative I was supposed to just WAIT until CD 45 when they would finally give me meds to bring on AF. Ridiculous!

As for meds- I've read that Metformin can be used to treat not only insulin resistance, but high male hormone levels- another common aspect of PCOS. I don't know the science behind it, but I know it's common to use in women who are PCOS but not insulin resistant. Your doctor should be able to give you a full explanation of why you're on it and what it is supposed to be doing for you. (If you're not getting a full explanation, I'd take that as just another reason to switch to an RE.)

I figure it this way. If your insurance covers anovulation treatment, and you can get that treatment from either a general women's health doctor or a well-trained and well-studied specialist, I'd go with the specialist any day. It's not that OB/Gyn's aren't great doctors, but a good RE is in a totally different category of expertise.

On a side note: I really do suggest starting with Femara rather than Clomid. I just finished my last dose of it today and have had very little in the way of side effects. All I had was some mild irritability and some very light hot flashes. So much better than Clomid. As sick as I was with Clomid, I honestly felt that, though I was O'ing, my body was just to ill to conceive. I am not feeling that at all with the Femara, and everything I've read about it just seems healthier that Clomid.