Sunday, November 6, 2011

PCOS Patient In India On Clomid: Needs To "Rest" Ovaries & No Ovarian Drilling!


Hi, I am G. from India. I am 26 yr old and I have PCOS. My LH level (14) is high on day 2. I am trying to conceive now. My gynae suggested me with clomid 100 mg from day 2 to day 7 and hmg 75 on day 2, 3 and 4. After seeing a developing follicle in my right ovary through ultrasound, I was injected with hmg 75 on day 8, 10 and 12. I had 2 eggs with 18 mm measurement on day 14. Then I was administered with hcg 10000 to release those eggs. Me and my husband was asked to have intercourse for 4 days and I was prescribed with progesterone supplement (400 mg) from day 15 for 10 days. In spite of all this, I didn’t get pregnant last month. My husband (age 28) has got healthy sperms. What could be the reason for this failure?

My gynae is suggesting for IUI (intra uterine insemination) this month. How long can I go about with this treatment? Will I succeed in conceiving if I get this kind of eggs in the following month? My gynae also suggests that she has to do a laproscopic drilling if I fail 1 IUI.

Please advice. Thanks in advance.


Hello G. from India,

First, you need to understand that fertility treatments are not magic. They don't work 100% of the time. What they do is attempt to restore your reproductive system back to normal, which in your case is to get your ovary to ovulate. For more, in depth information on PCOS please see: Polycystic Ovarian Syndrome.It looks like your doctor did a very good job of treating you in this cycle. She was able to get you to ovulate (probably two eggs) and you had intercourse at the appropriate time. In addition, she supplemented you with progesterone as I would have recommended. Now you need to do that repetitively, just as if you were trying for pregnancy naturally. If you or any woman were trying on their own, they would give up after only one try or wonder why they didn't get pregnant after one try, would they?

The only caveat is that because you stimulated the ovary, you need to skip a cycle in between to give the ovary a rest. You should go on the birth control pill that month to make sure that you have a period in a timely fashion, so you don't have to wait for your natural period to begin. Then you do the same cycle again I would recommend that you continue trying this for 4-6 cycles. Then if it does not work, you can consider other treatments. But, keep in mind that you are assuming that the only problem is PCO. If you have done a complete infertility evaluation, there could be other reasons why the treatment did not work. For that reason, you might want to do an evaluation before moving up to higher levels of treatment. I don't think IUI is an appropriate suggestion at this time. I also DO NOT recommend laparoscopic drilling under any circumstances!

Remember, what you are doing is a "natural" treatment method and your chances of pregnancy, at your age, is 18-20% per month. A normal woman (not using fertility treatments) can take 8-12 months to achieve pregnancy. So, just like someone trying naturally, you have to give yourself time. Don't let your doctor push you into more expensive treatments that you don't yet need.

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

Comment: Thank you so much for your advise, doctor. I am confident that I am moving in the right path now. So as u said I shall try this treatment for 4-6 cycles. Thanks for your time.


  1. Dr. Ramirez,

    Do you always recommend waiting a cycle after stimulating the ovary, or just for PCO patients? I am in the middle of a clomid-gonal-IUI cycle and if it doesn't work I think we'd go right into another one. Is it standard to take a cycle off, even if there are no cysts?

  2. Hello Janet,

    I recommend that the cycle be skipped if Clomid is used because Clomid blocks estrogen receptors and that will accumulate and lead to blockage of key receptors like the uterine lining, tubal motility and cervical mucous. If the ovaries are stimulated using Gonadotropins, like your case, the ovaries are being stimulated harder than normal and so I recommend skipping as well. However, that is not an absolute rule and with low dose stimulation, as is used with timed intercourse and IUI cycles, it is probably okay to do consecutive cycles.

    If the ovaries do not respond and there is no ovulation, then you certainly can try the next month because that is an indication that the ovary was not stimulated adequately.

    Good Luck,



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