Re: Getting VERY Frustrated

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Posted by Ellen Bender on March 23, 19100 at 07:44:32:

In Reply to: Getting VERY Frustrated posted by Jennifer on March 22, 19100 at 09:23:46:

Jennifer: Glad to see that you are under the care of a reproductive endocrinologist. REs are the most appropriate doctors for women with PCOS who are trying to get pregnant. Many (but certainly not all) OB-GYNs are not really trained to address all of the symptoms and underlying hormonal and metabolic imbalances of PCOS. I do want to respond to your statements about clomid. First, I think that in fact the majority of women with PCOS do respond to clomid but that there is a significant minority (@25% is the figure I've read) who do not respond. In addition, clomid's efficacy decreases with obesity so that may also have something to do with it. But the reason that many OBs and REs start with clomid is tht it is relatively inexpensive and easy to take (compared to injectible gonadotropins like follistim, etc.). Still, given the fact that a significant number of women with PCOS are clomid resistant, many PCOS savvy doctors I have spoken with have said that they will only do 3 or 4 cycles of clomid before moving on. The studies on metformin are promising and the data on metformin and clomid in women previously resistant to clomid (@89% ovulation rate) are even more promising but metformin is not without side effects and there is no data that I am aware of on a) metformin for women with PCOS who are not insulin resistant and b) the effect of metformin on developing fetuses, so there is some reason to be conservative. But you are certainly correct that women with PCOS should not have to be educating their physicians and it is important for women with PCOS to see physicians who are familiar with all aspects of the syndrome, including hyperinsulinemia. Ellen

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