Q: I am a 35 years old married woman and since puberty I have had the problem of irregular menses. I got married 12 years back and still have no children. I underwent diagnostic laparoscopy and was detected with endometriosis, polycystic ovaries and thyroid problem. I took Danazol, Metformin, Thyroxine (Eltroxin for some months) for many months and ovarian puncture was done too. But it did not help conceive. Presently my weight is 90 kg, which has increased by 7-8 kg within 4-5 months and is still increasing. I have hirsutism problem too with heavy hair growth on face, back, abdomen and legs. My androgen count was about 47%. Is it possible for me to get pregnant in this situation by either treatment, or by artificial insemination? Also, why is my weight increasing so rapidly? How can I reduce my weight?

A:Yes you can have normal menses and even get pregnant. The first step is to loose the weight, enrol in a weight loss programme with an endocrinologist and dietician. You will need to continue with the thyroxin, metformin, and also some ovulation (egg forming) drugs like clomiphene citrate or letroz along with Ultrasound scanning to time the egg formation with intercourse. The excessive hair too needs to be treated by regular hair removal techniques, for the old hairs, and medication like spironolactone for the new hairs. The improvement occurs slowly. As the weight reduces and menses become regular, and tesosterone (male hormone) levels go down, response to egg forming medication also improves. The treatment cycles may take 3-6 months, with several trips to the hospital, but success can be achieved. There is some small risk of more egg formation too, with increased risk of twins, or even abortion, but that is later on. First loose weight, second treat the hair with medication continue. Follow up with gynaecologist for egg forming drugs.