Sunday, April 11, 2010

Very Confused Woman With PCOS & Endo, Who Is Anovulatory: TTC & Not Getting The Right Treatment


I was recently diagnosed with PCOS, (after many years of suffering with endo also) and we've been TTC for 2 years. I have been taking 1,000mg/day of Metformin to help control the insulin resistance. I have long anovulatory cycles and was recently seen by my doctor who wants to put me on Ortho-tri-cyclen to help get my cycles back under control. She said that women with PCOS have too little of estrogen and that is why I am anovulatory.

I have always learned that women with PCOS are estrogen dominant, so now I'm very confused. Which is it? Also, will I see ANY benefit from the birth control pills, after I stop taking them? Will it help to make me ovulate? I have not ovulated since November, which of course makes it difficult to TTC without that important factor.

Thank you in advance. L. from the U.S.A.


Hi L. from the U.S.,

First, you are taking an inadequate dose of Metformin, if you have been found to have insulin resistance. The recommended dose is 1500 mg per day.

Secondly, your current doctor is incorrect in that OCP's (birth control pill) is only a treatment to regulate the cycles. If a woman with PCOS is not intending to become pregnant, then the treatment of choice is to use the birth control pill. This is the recommendation that medical doctors in my field will give you. That is mainly because the pill/patch/ring are made of estrogen and progesterone and override your ovaries. It will do nothing for your fertility. Also, the reason why you are anovulatory is because PCOS (polycystic ovarian syndrome) is an ovarian dysfunction that leads to low estrogen, high testosterone levels. It is NOT the other way around.

Once you stop the OCP's you will go back to your normal anovulatory cycles. If you want to get pregnant with PCOS, you need to use a medication that will induce the ovaries to ovulate such as Clomid, Femara or injectable medications. I would recommend that you see a fertility specialist, who understands this problem better and won't waste your time, so that you can get pregnant in the shortest period of time. My job, as an infertility specialist, is to try to get my PCOS patients pregnant. The goal is to get them to ovulate! We use fertility drugs such as the ones mentioned above for this purpose, but it varies as to how a patient responds to these medications. The "fertility drug" is actually stimulating the ovary to ovulate.

Also, keep in mind that endometriosis is also a cause for infertility so in essence, you have two problems that are preventing you from getting pregnant.

Please read further on PCOS in some of my earlier blog posts. There is one in particular with a link to a radio interview that I did on the subject. See the February blog post:

Good luck,

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


  1. I have the same, exact problem. I have been prescribed 2,000mg a day of Metformin. I lost my job in August of 2008 and finally found a job in January of this year. I have been without insurance this whole time. My new insurance will begin on May 1st so I made an appointment with a new OBGYN (because my other one retired). What are some of the questions I need to ask? I took Clomid for 6 months, had a period every month but my cycles got longer and longer each time.

    Is it true the egg isn't good if you ovulate later than your 20th cycle day?

    Amy from Tennessee

  2. If you have been on the Metformin for 6-8 months and your cycles have not become regular, then it is not working. You need to use fertility medications, as mentioned above, in order to stimulate your ovaries to ovulate. With fertility medications, your cycles should be pretty close to normal if that is an adequate dosage. If it is taking you 20 days to ovulate, then the dosage you are using is not adequate. It needs to be increased. Clomid can be used from 50 mg to 250 mg per day. In addition, you should NOT use Clomid every month. It blocks the estrogen receptors and will lead to a poor endometrial lining. It should be used every other month or alternated with Femara. You should check out my blog post regarding how I do Clomid cycles.



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