PCOS: How to Get Pregnant

Dr. David E. Simckes OB-GYN (Obstetrician-Gynecologist) Saint Louis, MO

Dr. David E. Simckes MD is a top OB-GYN (Obstetrician-Gynecologist) in Saint Louis, MO. With a passion for the field and an unwavering commitment to their specialty, Dr. David E. Simckes MD is an expert in changing the lives of their patients for the better. Through their designated cause and expertise in the field, Dr.... more

How to Get Pregnant if You Are Not Ovulating: PCOS

In the United States it is estimated that 15% of all fertile aged women don’t ovulate. The term Polycystic Ovarian Syndrome or PCOS is most commonly used, although it really doesn’t describe the condition. Fertility doctors usually use the term Ovulatory Dysfunction. Whatever the name used to describe your condition, it is important to realize that if you’re not ovulating then you can’t get pregnant. Some fertility clinics automatically push couples into expensive treatments such as inseminations and even in vitro fertilization without trying to solve the real problem which is to get you to ovulate. At Fertility Partnership we will make every effort to get your body to make a mature egg and get the ovary to release the egg so as to help you get pregnant “the old-fashioned way”.

The important thing is of course to make the diagnosis. There are three main criteria (Rotterdam Criteria) which are:

Irregular menstrual cycles
Ovaries that have a classic “string of pearls” appearance
Abnormal laboratory values such as glucose intolerance, elevated male hormones, or other irregular lab values.

When you come to the Fertility Partnership-FP we will get to know you, examine you, and typically draw some labs in order to best understand your condition. There are many conditions that would fall under the diagnosis of “PCOS” and so it is important to know them in order to help you ovulate. Inducing ovulation can be different for each patient and so a treatment plan will be drawn up and presented to you. We often use medications and sometimes we help with weight loss. Each case is somewhat different.

Once we have a plan in place we will then offer you a “Controlled Ovulation Induction cycle-COI”. We usually start with an oral medication such as clomiphene or letrozole (Femara) unless the woman has already failed with these drugs before and has had adequate surveillance with ultrasounds to demonstrate their effectiveness. Clomiphene is one of the most overused drugs in the country and can often cause more harm than good. Why? It is an anti-estrogen originally designed to treat breast cancer. While it may bring on ovulation it also thins out your endometrial lining which can decrease the chances of implantation of an embryo. The antiestrogen effect can also thicken the cervical mucus that is required to be thin to allow the sperm to pass up to the fallopian tubes. With careful surveillance with ultrasounds the negative impact of these medications can be minimalized. But, it requires inspection of your uterus and ovaries during the course of the cycle.

Sometimes the oral medications do not work. There is a name for this, “clomiphene-resistant PCOS”. If we discover during our surveillance of your cycle that you are not responding, we will offer you an injectable fertility medication. While these meds are a lot more expensive, they can usually force even the most resistant ovaries to provide mature eggs. Obviously, the risk of these medications is that you may ovulate more than one egg and the risk of multiple pregnancies is carefully considered and discussed with you. Again, the use of ultrasound is the best way to help you avoid becoming the mother of quadruplets or more.

At Fertility Partnership we understand that treatments for fertility are generally not covered by your insurance and so we’ve created a “COI Package” to give you the best chance at getting pregnant with these medications and help you avoid in vitro fertilization. During a COI Cycle one usually needs three or four visits, each with an ultrasound, in order to ensure ovulation. A patient might pay $200 or more for every ultrasound at other clinics. At FP our standard COI cycle is $350 which basically covers the entire month. We see you as many times as needed. We like to say that “you own us for the month” and can see us as many times as needed to be sure that your cycle goes well.

So many women don’t ovulate and find themselves being forced into protocols that cost thousands and thousands of dollars. At Fertility Partnership we want to give you the best chance to avoid all that if possible.