On September 29th I was interviewed by Sasha Ottey of PCOS Challenge on her BlogTalkRadio program, for an episode titled: "Ask The Fertility Specialist About PCOS And Your Fertility". I was pleasantly surprised at how quickly the one-hour interview went. It was basically a question/answer format (like my blog ). It was interesting to see how many questions I received from Sasha and her listeners that not only covered PCOS but many, many other issues that relate to women's reproductive health. For more in depth information on PCOS and infertility please see: Polycystic Ovarian Syndrome.
I will attempt to give you some idea of the many different issues that were brought up during this very enlightening hour! I can't list them all, but if any of the topics that I list below interest you, please listen to the radio show through the widget below!
- "What is the difference between a normal menstrual cycle and one that is PCOS?" With an abnormal menstrual cycle you can develop abnormalities in your endometrial lining.
- "What are the top reasons for infertility?" Probably PCOS is the number one cause for infertility that I see, with tubal factors and age factors coming in close seconds.
- "While overweight PCOS patients are told to lose weight, lean PCOS patients are at a loss as to what to do?" I go in depth on Clomid, Femara and the injectables that might be the treatment path for "lean" PCO patients.
- "What is the difference between ovarian reserve and ovarian resistance?" With ovarian reserve you need to evaluate your FSH levels and AMH and tends to come with age, but ovarian resistance has to do with how the ovary responds to fertility medications.
- "How long do you need to wait to try for pregnancy again after you have a miscarriage?" Surprisingly, recent studies have shown that trying as soon as possible will actually increase your chances of pregnancy. You must wait until you resume your normal menstrual cycle, though.
- "What about patients that are insulin resistance and overweight, will changing their diet and losing weight help with their fertility?" This will work in a majority of patients, but some of these patients will have to go on Metformin, and possibly ovulation inducing medication.
- "I am a very heavy-bleeder during my period and are there any options besides a hysterectomy?" You need to establish first whether you want to get pregnant in the future, in which case you want to preserve your uterus. You should find out why you have the bleeding. It could be an ovarian disfunction or perhaps caused by fibroids or polyps which can be removed. Otherwise, if you don't want to get pregnant you can opt to have a D&C, bcp, Mirena, endometrial ablation, or a hysterectomy.
- "When can I expect to see or hear the heartbeat in early pregnancy?" By the seventh week you should expect to see something.
- "Can you have menopause and PCO?" Once you become menopausal PCO is not an issue anymore, you have a hormonal imbalance because your ovaries are not functioning anymore. There are treatments for menopause, including estrogen replacement therapy for the first five years.
- "What is Metformin and Spironolactone?" Metformin is an insulin blocker, while Spironolactone is a diuretic used with PCO patients that have hirsuitism as well.
- "How do you treat nausea in pregnancy?" There is a great drug out there now that I use with all my patients, including those who have just had surgery, called "Zofran". It is safe for pregnant patients.
Not all the topics we covered are listed above...so tune in if you want to hear me discuss these issues and more in depth! Thank you, Sasha, for the opportunity to share this knowledge with your listeners!
Edward Ramirez, MD, FACOG
Monterey Bay IVF