Is annovulation normal?

[dms621]

Hello.

My husband & I have been ttc since January 2007 (almost 2 years) with no pregnancies. We've gone to a RE and he said my bloodwork was normal and the semen analysis was also normal (he did say sperm shape is a little less than "standard" but nothing major that concerned). I've only had my period 3 times this year on my own (12/31/07, 5/10, 9/10 and then on 10/27 with provera). The Dr said he believes I'm just not ovulating. My question is, is this normal? Is there no concern that I'm not ovulating and menstruating normally?

He's prescribed Clomid days 5 through 9 of my cycle after taking provera again. Is there anything else I should encourage being looked into? I just worry they're missing something that would explain my lack of menses.

Thanks in advance!

[Scott Roseff MD]

Hi,
Glad you asked! It's highly abnormal to have only 3 periods/year on your own. This hormone imbalance can certainly make it harder to get and stay pregnant. It's imperative that an RE tell you WHAT your diagnosis is (WHY you're not ovulating regularly) in order to maximize your odds of success. For example, if a woman has irregular periods due to PCOS, she may have an increased risk of miscarriage, high blood pressure during pregnancy, diabetes during pregnancy, as well as increased lifetime risks of cardiovascular disease and diabetes. There's also an increased incidence of thyroid disease in women with PCOS.

Make sure your RE tells you what your diagnosis is, and make sure that PCOS has been either ruled in or out. IF you do have PCOS, ask if you are insulin resistant or not. If the RE won't give you a proper diagnosis, find one who will! As an aside, if you do end up taking Clomid, make sure you are monitored for ovulation while taking it and make sure your ultrasound shows a thick enough uterine lining (as Clomid can cause a thin lining).

I hope this helps!

[dms621]

Thank you so much for your quick response. I'm SO glad I asked because I just assumed it was normal. The Dr. said all of my bloodwork came back normal (glucose included). When I first went to the Dr, I had done research online and felt PCOS fit me almost perfectly, but he said he "...can usually pick women with PCOS out when they come in".

In the past year, I've had horrible acne, a little bit of weight gain (nothing too substantial, I thought it could be that I'm in my 30s now), depression (which I've had for many years) and anxiety (this is recent, about 6mos to a year). I do have some hair growth, but nothing like a full beard or anything, but some thick, coarse hairs here and there on my face, chin, stomach - a lot there - and even on my chest). In case it matters, I had a vaginal ultrasound and everything was fine (no cycts).

At our most recent appointment where we got our test results, I was sure to ask two times, "so this is normal" and he said I was just one of those women who ovulates less frequently. Now I'm wondering how is PCOS diagnosed? After you've mentioned this, I'm considering finding a new RE because I would've hoped the Dr would've given me a diagnosis before starting treatment. Maybe I can get my files transferred to a new Dr and try to get a diagnosis from there?

Thanks again!

[Scott Roseff MD]

I'm an authority on PCOS, and you're certainly welcome to come here (see this link). PCOS is based on a history, physical examination, and testing. The testing should also rule out other disorders that mimic PCOS (such as LOCAH).

Hope this helps!

[dms621]

Unfortunately, I'm in PA, so it would be difficult to come down there for treatment (if I were local, I'd be in your office asap!) but you've given me a lot to consider. I'm definitely going to look for a new RE. Maybe one closer to Philadelphia, which is 1.5 hours away. I should've gone with my gut instinct of "the Dr is nice, but I just don't feel 100% comfortable with him" and looked for a new Dr. At least I didn't start any treatment yet!

Thanks for all of your help!

[Scott Roseff MD]

You're welcome!
Good luck - Dr. Roseff

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