Miscarriage [Archive] - Insulite PCOS Forums

drheather

01-23-2009, 09:38 AM

Dr,

I had a low progestereon and had a miscarriage in the 8th week this sep 08.I did take vaginal suppostries , but didnt help i guess.
My doc in India 5 years back said after the ultrasound that I have pcos, but all my blood reports where normal. Generally they say if LH is greater than FSH its pcos.But mine was normal. Inspite of that she prescribed me Metformin. I discontinued it after 3 months when another doctor suggested me not to.

I moved to USA and after 3years(I started only trying in feb 2008 and got pregnant in Aug 2008) I got pregnant and ended up having a miscarriage. My doc again did my blood test- fasting and everything was normal. However she still recommended me metformin.

I took second opinion from another doc a month ago and she asked me to stop Metformin saying ur reports look normal u donnot have pcos.She prescribed me with folic acid folgard.

I have a regular 35-40 days cycle.
I am so confused now. I am trying to get pregnant again and I am scared to loose my baby again.

Any suggestions for me

- Manju

Dear Manju,

Thank you for writing in. I am sorry to hear about your loss.

I hope that I can provide you with some helpful information. First, I know understanding PCOS and how to diagnose it can be very frustrating. It seems as though the first ultrasound that was done showed cysts that indicated to that doctor, PCOS. Even though the labs were normal, it is still possible that PCOS is present.

Also, even if the cysts have resolved, PCOS may still be present. Not every women with PCOS will have cysts on her ovaries. The cysts that indicate PCOS are small multiple, cysts that resemble a string of pearls. Characteristically, they are different than other ovarian cysts. They are actually underdeveloped follicles that form in some due to lack of ovulation.

In a case that is not clear and others, it is important to rule out other conditions that can present with similar symptoms as PCOS.

You mentioned that you had low progesterone early on in the pregnancy. This is not uncommon with PCOS. Here is some additional information on the tests.

- testosterone- elevated in PCOS

- DHEA-S- elevated in PCOS

- fasting insulin- elevated in PCOS. Some doctors may hesitate to order this test because the normal range (0-20) is so wide. However, we find that results greater than 9 indicate insulin resistance.

- fasting glucose or glucose tolerance test- elevated in PCOS. Using this information in combination with the fasting insulin helps to diagnose insulin resistance. Also, women with PCOS have a higher risk of diabetes so it is important to screen for this early and often.

- LH:FSH- Some doctors may also look at the ratio between these two hormones. In PCOS, we would expect LH to be elevated in comparison to FSH. I understand that yours did not have this shift.

I would ask your doctor to perform a fasting insulin if they did not. Often only a fasting glucose is done and although this may be elevated, we may not yet see this change.

Do you have any other symptoms of PCOS? To diagnose PCOS, we use a combination of clinical symptoms (what you experience as the patient, such as excess hair growth, irregular menses, acne, skin tags, weight gain, infertility, etc.) and lab tests. At 35-40 days your cycles are a little long. But from what you wrote they are regular every month.

Other conditions that may cause similar symptoms include hypothyroidism, Cushing's disease and Congenital Adrenal Hyperplasia. However, these will be considered if your symptoms are similar to what is expected in these conditions. Your symptoms may not reflect that.

If all else has been ruled out and you are still having problems, you may want to reconsider the diagnosis. Also, be sure that the doctors are familiar with PCOS, even the cases that are not very clear. The doctors that did diagnose you with PCOS, felt or suspected that something was going on and that is why they concluded what they did. That is also why they prescribed metformin. This is often used first along with birth control pills to regulate periods (if irregular or absent).

Also, what would be important when you are ready to start trying again, to have some blood tests done before to see where your levels are so that they can be checked and monitored when you get pregnant. Your history of low progesterone should be looked at and supported if needed with pre-pregnancy/pregnancy.

You can also start tracking your ovulation. There are a few ways to tell whether or not you may be ovulating. One is the presence of regular menses. Other signs of ovulation include a shift in the basal body temperature and the presence of fertile cervical fluid (also called "egg white" mucus or spinnbarkeit). You can read more about how to monitor your fertility signs by reading the book “Taking Charge of Your Fertility, 10th Anniversary Edition: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health” by Toni Weschler. I highly recommend reading this book because you will definitely gain a better understanding of your body and optimizing your chances of becoming pregnant. You may also want to check out the following website regarding the Fertility Awareness Method: http://www.ovusoft.com/library/primer002.asp

I know that I may not have provided you with the answers you are looking for. But I can only hope that you now have more information to proceed. If you do find that PCOS is the problem, I would recommend the Insulite PCOS System.

Manju, please let me know if I can help further.