Saturday, June 27, 2009

New Blog Format

Just to let everyone know, after a long hiatus, I have returned to this blog and plan to do something new. I am a expert on a site called, which provides free questions to experts in various fields. I am the expert for the field of Women's Health and Infertility. I have been a part of this for quite a while now, and have been answering questions from all over the world. I thought you might be interested in reading some of these letters and answers. It will enhance the information I provide to readers. I have therefore decided to put some of these questions and answers on my blog for you to read and comment on. I hope it is helpful and interesting. I get these questions daily, so will be placing them here as often as I can. Here's the first one:

Hello, Thank you so much for taking the time to answer my quetions.

I am a 29 year old Type 1, Insulin dependant Diabetic tyring to conceive for 16 months. I was diagnosed in 2005. I have about 6 periods a year that last between 10 and 20 days. They are also getting worse, currently I have been bleeding for 30 days! After 1 year of trying unsuccessfully my family doctor referred me to an ob/gyn who diagnosed me with PCOS based on blood tests, ultrasound, irregular periods and hirsutism. The new doctor was unsure of whether or not to prescribe Metformin to help stimulate ovulation because I am already taking Insulin. She was unsure what impact it would have on my blood sugar. She ordered blood work to verify if I have ovulated, but I have been unable to do it because of the continuous bleeding. She also suggested testing for tubal blockage, but that has not happend yet. I live in Northern Canada and the nearest fertility clinic is an 8 hour drive.
My questions are: Is it worth trying Metformin or should I go directly to Clomid? Should I consult an RE now and travel to see them or will my ob/gyn be able to help?
My next appointment with the doctor is 2 months from now, should I proceed with contacting an RE before then?
Again, thanks so much for your help.

If you are requiring insulin, then you are not a PCOD with insulin resistance. Those type of patients make insulin, and their serum levels are elevated, but the insulin is not getting into the cells, hence the diabetes. You absolutely should NOT go on metformin!!!

You are more complex than your general Ob/Gyn doctor. You need to see an RE or infertility specialist. Most PCOD patients do not respond to Clomid and either need to use a combination protocol or straight injectables.


Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

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