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Will I be able to conceive?

Q: I am a 28 years old woman. I was reported with polycystic ovaries 4 years back. I had irregular periods happening after 40-45 days. I was prescribed Novelon tablets for six months. After that, I started getting my periods, regularly. I got married one and a half years back. Novelon was again prescribed as a part of contraceptives. I used these tablets for 6 months and then stopped. After that I didn't get my periods for 3 months. My doctor asked me to take Meprate. This happened again after 3 months. After that I used Clome (50mg) and Duphaston tablets for two cycles. After the second cycle I underwent a follicular test. There was a good progress in ovulation for that month but I couldn't conceive. Then my gynaecologist advised me to consult a test tube baby centre. Here we tried for another cycle with Siphene 50mg. There was no egg formation even on the 16th day scanning. Now I am using Siphene 100mg along with Premarin 0.650mg and Tamoxifene 10mg tablets. Am I going on the right track? I don't have any other health problems. I have undergone all the tests for hormones and thyroid. The reports are all fine. Can there be any side effects of the treatment I am undergoing? Can I get pregnant? I am not getting periods, without the help of medicines. Why is this happening? Have I gone for the treatment too soon? My doctor has told me that the ovaries will get resistance to the tablets I am taking. Is it true?

A:Polycystic Ovarian Syndrome or PCOS as it is sometimes called, is a very common but complex condition. There are a group of varied manifestations and a wide spectrum of symptoms, none or all of which may appear in individual women. I suggest you read more about it and try and understand how it should be managed. At the outset I want you to understand this it is not a disease, not even a disorder but just a variant of normal. It affects almost 20 % (one in 5) of all women. It is so common that could not be called a disease or a disorder. It starts in your teen age and gets more severe to peak in late twenties and early thirties (your age group at this stage) so while you were getting only delayed periods 4 years ago, now you almost do not get periods at all. This is age related and not due to your taking the contraceptive pill over the last few years. I would say that for your body to function normally, you need normal level of hormones and the normal biorhythm. The amount of female hormones secreted in the body varies according to the time of the menstrual cycle, and it follows a sine curve with a peak in the middle of the month coinciding with the release of the egg followed by a pregnancy / degeneration of the egg and a trough in the levels occurs just before the periods, triggering the menstrual flow. In PCOS this sine curve like rhythm is lost. This loss of rhythm may happen temporarily in most women once in a while because of many reasons like change of lifestyle, travel, stress, lack of sleep, exams, broken relationships etc. but happens more often in PCOS. Women who do not have a PCOS therefore make an egg 10 – 11 times a year and do not only once or twice a year. While in PCOS it may be reversed. So though you may sometimes make an egg you obviously do not make one every month (from your history of periods). In other words, you do not make an egg each cycle, and the cycle you do not make an egg, the period does not come in time / or there is no period at all for months. This means that you will take some medical help to ovulate and conceive. Besides the main problem in PCOS is too much oestrogen (the female hormone) in your blood. The OCPs (Oral contraceptive pill) keep your rhythm in check and lowers your oestrogen level. You have mentioned that your hormone levels are normal, which I expect them to be. But the LH FSH Ratio may be altered. This frequently happens in PCOS. But the gold standard of diagnosis is achieved through the typical picture we see of the Ovaries in the ultrasound, immediately after the period. This should be done to confirm the diagnosis of PCOS. If you are planning a baby, should you be treated? Well you ovulate erratically and the periods are unpredictable, so it is not that you do not make an egg, it is just that we never know when you do. And if and when you do make an egg we will never know when to time sex to optimise your chances of conception. Though you will be better off if you conceive without treatment but this may take years. You can increase your per cycle conception chances by taking minimal dose of a drug like Clomiphene and well timed sex. Like all women who have some fertility issues, you seem to be already questioning your chance of ever being a mother in this lifetime. This is the anxiety that the whole infertility industry cashes on. Ninety percent of women with PCOS ovulate with drugs but only about sixty percent conceive (within one year of treatment). The others show other factors for sub fertility. And there is no reason whatsoever to believe that you will not eventually have biological children of your own. Every time two people get married, there is a 10% chance they will never have a biological child for whatever reason. Your chance is not any more or less. Barring other reasons like the male factor infertility, you should be able to conceive with minimal treatment. You will ovulate with the right dose but conception and then carrying is a complex problem. A woman's body is complex and never responds predictably. You may require many months of treatment with predictable frustration. You are taking drugs like Progynova, Tamoxiphene and Duphastone. These are a cocktail of hormones and may be required in isolated and refractory cases but not in a person like you who has just started treatment. Because all these drugs are being given for things like reducing baseline oestrogen level, supplementing oestrogens and progesterone, all of which are manipulations which are done in individual clinics as protocols, without any real evidence that they help. In fact, a large number of studies show that far from improving your chances of conception, these may lead to long term side effects.

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