Hi,I have several questions I am hoping you can answer for me. I am 31yrs old and have been diagnosed with pcos. I have elevated testosterone and high LH, but all other test results are normal. My sugar levels are completely normal. I am trying to conceive, and just finished my first cycle of clomid 50mg , also the doctor has put me on 850mg of metformin. So these are my questions:1) My testosterone is 98 one number and the free testosterone is 8, I have no clue what these numbers mean, but would you consider them to be slightly elevated or very elevated?2) I am not insulin resisitant, so I am wondering how is the metformin going to help me with conception? and also, will it lower my testosterone levels?3) what do you think my chances of conceiving with the combination of clomid and metformin together are?4) Should I take robittusin cough syrup to help with the cervical mucas that the clomid may dry out?5) I normally have 38-42 day cycles, so will the clomid regulate my cyles to 28 days or should I expect a 40 day cycle again? In other words, I want to know when should I expect ovulation? ( my 1st day of my cycle was June 14th and I took the clomid days 5-9)??6)what days should I be having sex? everyday or every other day?I am sorry for all the questions, but I really need to know these things. Thank you for your time
Hello, and I am pleased to help, use of my answers are for educational purposes only.I look at total testosterone and 98 is VERY hight.Actually YOU ARE insulin resistant - even though your glucose numbers are normal - your testosterone levels tell me that you are insulin resistant - this is just how when you at how partitlces are made in the body - are - (by the way this takes a semester's worth of material in medical school to explain why - but you are).Metformin you need to be on at least 1500mg per dayClomid - Only works in my experience when you use 100mg Your cycles are should be between 24 and 35 days, and NO, clomid does NOT regulate your cycles that is NOT what clomid doesAs for having sex, you should have sex days 12 through day 17 (daily).I hope this helps, Please click on ACCEPT, thank you
I appreciate your response, however, I feel you did not cover some of the questions I asked .. Can you please answer these questions specifically for me:1) So how is the metformin going to help me ? and is it going to lower my testosterone levels?2) What do you think are my chances of conceiving with both the clomid and metformin together?3) Should I take the robitussing cough syrup to help thin out the cervical mucas?4)If you are saying that clomid will not regulate my periods, then how am I going to get a 24-35 day cycle with the clomid if I normally have a 40 day cycle??I would really appreciate if you could answer these questions in numerical order so I am clear and undrerstand everything thank you
As I have said, the steroid synthesis cycle is a semester's worth of material - but I'll give you the quick synopsis - With PCOS _ you have elevated estrogen levels in the form of estrone and this in turn increases the testosterone levels and this in turn increases the insulin levels and then this in turn then increases the capsule thickness around your ovaries which causes you the inability to ovulate and hence you can not release an egg and hence you have irregular cycles and this is where Metformin will help.You use clomid as a Estrogen and Anti-Estrogen medication to give that extra 'surge' to enable your ovary to ovulate - but unless you have been on Metformin at 1500 mg per day for at least 3 months this will not work because your capsule around the ovaries will still be too thickc - and hence you need the metformin to continue to work to decrease the thickness.Clomid was NEVER meant to regulate your periods - so whoever told you that really does NOT understand how clomid works.Please click on ACCEPT and I would then be happy to answer more, thank you.
Ok, thank you for trying to explain it to me, I have pressed accept, can you please answer the rest of my questions: 1) so is the metformin at a higher dose going to lower my testosterone levels to normal?2) What do you think are my chances of conceiving with both the clomid and metformin together?3) Should I take the robitussing cough syrup to help thin out the cervical mucas?4)If you are saying that clomid will not regulate my periods, then how am I going to get a 24-35 day cycle with the clomid if I normally have a 40 day cycle?? I do not understand how I am going to ovulate around day 14 if I have 40 day long cycles normally. Can you please explain this?
Metformin should help you decrease your insulin levels and then hopefully decrease your testosterone levels.And, let me start by saying if everything was PERFECT meaning you did not have PCOS and you had a regular 28 day cycle the chance of pregnancy if you had sperm in the fallopian tubes at the appropriate time - the chance of pregnancy is still only about 20 to 25%. So, for YOU - with PCOS, and even the use of Metformin and Clomid and then also Inducing your period with Provera - the chance of pregnancy is about 10% if everything is done right as I explained.As for Robitussin - I really do NOT believe it works although some doctors are saying it does - I have yet to see this work.Yes, clomid is NOT a regulator of your periods.To help you get a period - you need to use Provera for 5 days every cycle and the day you bleed, that is Cycle Day 1 (CD1) and then on Cycle Day 5 through 9 you use clomid, and then you have sex days 12 through 17, DAILY.Take care.
Ok, so sorry, but I have a few follow up questions.So if or when I get pregant, are the testosterone levels going to balance out on their own and then they will be normal during the pregancy?As far as the clomid, I still do not understand, if its not going to regulate my periods, then how is it that I am expected to ovulate on cycle day 14 or 15 when my periods are normally 40 days? I am very confused about this.Lastly, I would like to know if I was not trying to conceive, would the birth control yasmin completly balance out my testosterone levels by itself or would I need another medication such as spironolactone in addiiton to the yasmin? Thank you
When you get pregnant testosterone levels should not be a concern at this point - but they should decrease a bit during pregnancy.Clomid is an Estrogen AND an Anti-Estrogen in the same pill - it is meant to help you Ovulate - NOT to regulate your cycle. It will help you ovulate - this does NOT mean it will regulate you to a 28 day cycle - and this is where the Provera comes in - we Artificially cause you to have a period...Yaz, Yasmin or Demulen would HELP you decrease the testosterone levels, but also Eating right and also exercising will help control your insulin and testosterone levels.
Relist: Answer quality.I have asked very specific questions from this doctor, and I keep getting unanswered and its very frustrating
I am sorry, but I really feel you are not answering me directly , can you please refer me to another expert who can answer my questions thanks
Okay - please ask directly what you are asking - I thought I was very complete -
Ok, I will ask very directly, but if you feel you do not want to answer, please refer me to another expert.1) is the metformin at 1500 mg daily going to just lower testoserone a little, or should I expect it to bring it down to normal ( what a woman with no pcos would be) along with good diet?2) with the clomid, when should I expect to ovulate ( I got my period june 14, then took clomid june 18th -22nd) so when should I expect ovulation? and when should I take provera after that?3) If I was not trying to conceive, would the yasmin alone bring my testosterone to a normal level along with good diet, or would I also need spironolactone in addition to the yasmin?4) is the 50gm of clomid still going to give me a good shot at ovulation?
1. If you look at my previous answers I did answer that and I know you are looking for ABSOLUTE answers, but there are NO absolute answers - hence it 'could', but no guarantee.2. with clomid taken on days 5 through 9 you could usually ovulate about 4 to 6 days after you stop the clomid.3. Yasmin 'Could' decrease your androgen levels (hence your testosterone) levels - but again no guarantee.NO, do NOT ever use spironolactone if you use Yaz or Yasmin - you can use spironolactone with another form of birth control4. I never use just 50 mg of clomid because years ago when I did, I NEVER saw results so Hence I always prescribe 100 to 150mg of clomid.I hope this helps, thank you.
ok, thank you,My only other question is would you as a ob prescribe the yasmin only to lower the androgens, or would you prescribe the spironolactone? which is better to lower the testosterone levels?and as far as while I am trying to conceive, besides the metfromin, what can I take as far as medications that are safe while trying to conceive, what can I take or do to bring down testosterone levels?thanks
Yes, I do prescribe Yasmin and yaz to help decrease androgens - because the Yaz and yasmin have drosperinone - which is essentially the same as sprionolactone.there really is nothing else to take- but I do recommend taking Metformin Daily - and this is very inexpensive relatively speaking because it is now in generic formula - about 5 years ago it was still name brand.Take care.
Hi,So as I mentioned before, I took the clomid days 5-9, and today is cycle day 11 and I used an ovulation prediction kit and got a positive, so my quesiton is how is it possible that I got a positive so quickly? I thought I would not get a positive until at least 3-4 days after my last clomid pill. Today is only 2 days after my last clomid pill. So what does this mean? and based on this, when am I going to ovulate and when shoiuld I have sex?
So I am still wondering why I got a positive opk test result just 2 days after my last clomid pill. Is this a false positive? I have heard you can get false positives if you test too soon after the last dose... So do I need to test again in a couple of days?
Well the OPK is NOT really looking at ovulation it is checking your LH surge (luteinizing hormone surge) - and in some women the LH surge can be above the threshold level of the test kits for more than a few days - but it is hard to say otherwise - so yes this could be a false positive too. I would just follow the directions on the box and if you are using clomid on days 5 through 9 and you are getting a positive on day 11 - then I would just start having sex on that day, and have sex everyday for the next 5 days to ensure that sperm is inside of you for when you ovulate.Thank you for your questoins.
Thank you, XXXXX XXXXX am I really ever supposed to know for sure if I am ovulating? Normally, with opks, how many days will it show a positive? Is it just a one day thing or will it show a positive for a few days?The other thing I want to know is I am very confused about this bbt charting. So I understand that if I chart my bbt from cycle day1 and everyday onward, that the rise will only be AFTER I have already ovulated, when its too late for conceving, so then what is the point of doing the bbt, if one only gets a rise after the ovulation window is over?-also, I am sorry if I seemed rude from the earlier posts, I just was so anxious and confused about all these fertility issues, and just wanted answers to my specific questions thank you I await your reply
That is one of the more difficult questions to answer - and hence why I usually recommend having sex on a daily basis like this.And usually when I work with women who are trying to get pregnant - I usually have them come into my office and we do a quick daily ultrasound to measure the size of their ovarian cysts - because ovulation usually occurs when a cyst approaches 2cm - so this incombination of doing the OPK helps.With temperatures - ovulation occurs usually within 24 hours of having that 'spike' in temperature - that is due to the surge in LH - so having a combination of all this such as temperature, OPK and ultrasound will help.But, having daily sex is your best method of ensuring sperm is sitting in the fallopian tube when the egg arrives. Sperm can live up to 72 hours in the female genital tract too.Thank you for your questions
Ok, so just so I understand clearly, is it true that just a couple of days prior to the bbt temp rising, that there will be a decline in temp, and during that decline is when its right befor ovulaiton?- also, I have read that daily sex can lower or affect sperm count and that every other day is better, is this true?
There might be a decline in temperature - but what you are looking for on a chart is a temperature spike - and this is why you put it on a chart because it can be a subtle spike but when you visually see it on a chart (connect the dots), then it happens to be more visual to you. So, having sex when you see the spike is when you should start to have sex.Daily sex might lower the sperm count a bit - but there will definitely be adequate sperm with each ejaculate if the guy is healthy and has a normal sperm count to begin with. So you can do this every other day since sperm can live for 72 hours, but having sex everyday sometimes allows more sperm to be present and available.
Today is cycle day 12 for me and I have not gotten a positve opk. I have only gotten one positive opk, and that was yesterday on cylce day 11. I am thinking that was a false positive because it had only been 2 days since my last clomid dose, would you agree it was most likely a false positive?/? also, I had a few questions:1) normally, in your experience, women who take the clomid on days 5-9, when do they normally ovulate? whats the latest you have seen? I am wondering this becasue I want to know if it is still too soon for me to worry? Can ovulation still happen in few days?2) is it ok for me to take the progesterone test on cycle day 23 or 24 instead of cycle day 21?3)what minimum number on the progesterone test would show that I have ovulated and that I am producing enough progesterone?4) if i get back the resulsts of the progesterone test and it has indeed shown that I have ovulated, does this mean that the clomid 50mg is fine and I should stick to that dose on the next cycle?? and if the progesterone test showed that I ovulated, does this mean that I woud not need injection shots to help me to conceive and that clomid is enough?
Yes it could be a false positive, usually you should get a Positive OPK more like around day 14Yes, if clomid on days 5 to 9, ovulation usually around Cycle days 13 to 15Yes, you can take progesterone starting anytime after ovulation - so day 23/ 24 is okay.I would not do a progesterone test until after you have a positive pregnancy test.Progesterone test really has nothing to do with you having ovulated - because it does not show or prove ovulation - just that a low level of progesterone with a positive pregnancy test might need some extra progesterone.I hope this helps, Please click on ACCEPT, thank you
I do not understand, if progesterone has nothing to do with ovulation, why do they do a day 21 progesterone test to see if ovulation occured?- also, how am I supposed to know if the clomid made me ovulate or not? If I keep getting negative opks, then how can I know for sure?- and how can I know if the clomid 50mg is enough to keep same at next cycle or if I need to go up to 100mg?
Progesterone is made from the Corpus Luteum cyst - what I am trying to say is that the cyst that the ovum (the egg comes from ) is Not from the corpus luteum cyst.And, Progesterone is at a certain level in the Luteal phase the 2 weeks prior to your period and if you do get pregnant, the HCG then signals the corpus luteum to increase the 'output' of progesterone - so Ovulation in of itself really has nothing to do with the Progesterone in the sense that it signals ovulation - I hope that helps.The best way to know if clomid works is but doing daily ultrasounds from days 12 to 16 - which is what I do on women who are using clomid.And, I Usually use 100mg of Clomid, I have never found 50mg to work.I hope this helps, thank you for your questions.
thank you,So on a day 21 or 23 progesterone test, what minimum number would show good results usually? what is the range I want to be in when the results come back?
basically, I want to know what number on the progesterone test would be a good number to have, and also, the ultra sounds you are talking about having done while on clomid, what days do I need to have them? and what are they looking for during ultrasounds?
I usually like to see a number of at least 17 to 24 by the day of your missed period,.I usually do ultrasounds on days 12, 13, 14, 15, 16 and I am looking for an ovarian cyst that is greater than 1.7cm