# PCOS and medicated IUI. Had no idea..



## greatgazza (May 27, 2010)

I seem to have been verging on PCOS then classed as not PCOS on and off over the years and have never really been given a final answer...  I thought I wasn't.  I went to see my GP (to get clomid etc as she had said she could prescribe it but then said she couldn't...?) who said maybe I shouldn't go for medicated IUI as it appears I'm ovulating so there would be an issue with possible quads etc and them all dying... I emailed Stepan at reprofit  with my last FSH/LH results from Dec 09 just to say my GP had said maybe i should go unmedicated.  He replied my results were PCOS like and agreed with my GP that i should go unmedicated.... talk about confused.com.  My GP wasn't saying she thought I should go unmedicated due to PCOS just that maybe i should give unmedicated a go and I had no idea of the potential risks until i then googled them after Stepan's reply.  Talk about going into the lion's den...one minute it's this and the next it's that.... maybe that's the price you pay for not paying the price over here?....

Also if i hadn't offered the information to Stepan he knows nothing about me medically.....is that just the risk you take and he expects you to know all the information about how you should proceed....they are just the facilitators at reprofit??


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## Annaleah (May 14, 2008)

Hi Greatgazza

I don't know much about Reprofit but from what I gather a lot of the ladies have some of their monitoring over here before they go - some have scan over there a few days before they arrive to check follicle number and size, and sometimes have trigger shot.  They would be the best people to ask about treatment over there and things like getting hold of Stepan and what level of advice he gives.  I guess it is partly your preference about treatment protocol and what is in your best interest given your endocrine and medical status. 

Re the PCOS - some women with PCOS do not ovulate which is why clomid is used as a first line treatment as it stimulates ovulation.  My understanding is that it does not control the degree of stimulation, therefore other FSH drugs (eg gonal f ) are used for some IUI and IVF cycles as you can have greater control with these.  Some women with PCOS are at risk of high ovarian response even to low dose stims which will be the risk of multiple pregnancy that your GP was concerned about. Some women with PCOS even produce multiple follies on clomid.  I had an IUI cycle cancelled because I had 27 follicles (only 5 big enough to contain a mature egg) but the risks if all five had fertilised meant the clinic would not proceed.  

My personal opinion is that if your bloods and scans are suggestive of PCOS then it is important to have a monitored cycle with scans to check follicle numbers and sizes, and with bloods to check oestrogen levels (also to check for LH surge so IUI can be timed correctly if you're not having trigger) so that safe decisions can be made about your treatment. Also I think (again this is personal opinion and not everyone will agree with me) that if you are having unmedicated cycle it is still useful to have some form of monitoring so that you can have information about follicles and so IUI can be timed correctly.  Otherwise I think it's a bit like shooting in the dark.  If you have unsuccessful cycles you never really know if you were basted to early/ late or if the follicle(s) were big enough to contain a mature, fertilisable egg, if it was a problem with lining - and this makes it difficult to make informed decisions about future treatment.

Wishing you well with you tx decisions and feel free to PM me.
Annaleahx


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## greatgazza (May 27, 2010)

Thanks for that Annaleah.  So if one does get monitored over here, with bloods etc how do you go about getting that?  Do you get referred to a gynaecologist privately and pay for them to do what you need to have done over here?  I had obviously planned to have the US scan on day 10 that Stepan requested, what other monitoring could be useful i.e. how often and when do you have bloods done etc..

Greatgazza x


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## Annaleah (May 14, 2008)

Greatgazza, 

The clinic that I was using suggested a scan and bloods on day 9 (they leave this till day 10 for 'normal' responders) and then 48 hrs later because of my high response(this was on antagonist regime using low dose gonal f).  I imagine a day 10 scan would be enough to see how things are looking and then if they are concerned they can advise.  I guess you would only need extra monitoring if there was a problem (e.g too many follies, lining problems).

I think there have been a couple of ladies on the IUI thread who have had to cancel a cycle recently because of having too many follies or surging too soon (the second one isn't so much of a problem if you can access the clinic sooner for IUI). 

I had all my monitoring done at the clinic.  Your GP may agree to do bloods, but you may have to pay and they are not always back quickly enough!  There are several places in London e.g Birth Company on Harley st which others have used for scans - i'm not sure whereabouts you live but it should be fairly easy to get a scan locally.  I don't know how useful/ necessary bloods are if your doing IUI, especially if you're using trigger shot (as long as this is timed to preempt your natural surge!) but these can usually be sourced at the same place you would get a follicle tracking or lining scan.  Your GP or local obs & Gynae dept might know private practitioners - but it seems easier just to go to one of the established private centres.  I'm sure someone will be along with more info about this.

Annaleah x


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## morrigan (Dec 8, 2009)

Has your gp got specialist gynae  knowledge? Some do because of previous experience but most gp are generalists in this area and my not have up to date knowledge about use of clomid in these circumstances - is your gp referring you to Nhs consultant? I've been doing unmedicated unsuccessfully and am thinking of switching but my clinic have said they won't go ahead if your scAnned with more than 3 large follicles which would obviously reduce this risk- multiples are risky but there are safeguards to reduce risk without not taking drugs. Pescribing fertility drugs without proper monitoring is irresponsible so I can see gp's reluctance If he's not in control of that monitoring which us normally done by specialists in Nhs. You can get private prescriptions if you want meds - ask one of reprofit girls- prob a few on here that have pcos.

Good luck with making descions xx


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## bingbong (Dec 9, 2008)

I have PCOS and told Stepan about this and he still wanted me to have 100mg of clomid, I was worried about this as most people start on 50mg and I figured with PCOS I'd likely over respond. But the first two cycles I didn't come anywhere close to that, if anything I could've done with a bit more of a boost. Then the third cycle my body seemed to work out what was going on and I produced a few good sized follies, can't remember how many, think maybe three that were big enough for mature eggs. That one worked and I am pregnant with twins and obviously very happy. 

I also found it odd that Stepan didn't ask any medical questions and only knew what I had told him but it all worked out in the end. The thought of twins was ok for me and I liked the increase chances of a BFP with clomid which is why I decided to go for medicated, I also thought that it made the timing etc easier with going abroad but that might not be true.

Good luck.
bingbong x


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## upsydaisy (May 9, 2009)

Hi Great gazza
Like Morrigan said PCOS is an area which many GP's are next to clueless about.  Clomid is pretty standard treatment for PCOS, although my problem (like many women with PCOS) was a  lack of ovulation.  I only got one undersized follicle on each attempt with clomid but as you can see from the pic of my giant sized daughter I'm not complaining   .  I was also told that IVF wouldn't be recommended due to the risk of over stimulation.  The drugs used are much stronger than clomid. I had two scans each time.  They can see the number of follicles so will not let you go ahead if there's a chance of becoming the next Octomum  
Hope that's of some help   
Upsy
xxx


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