Problems getting pregnant after tubal reversal surgery,pregnancy medicine for vomiting,poems on being pregnant - PDF 2016

Polycystic ovary syndrome, or PCOS, is an endocrine condition in which a woman has an imbalance of  female sex hormones.
For non-insulin resistant patients the treatment varies, depending on whether a patient is trying for pregnancy or not.
One of the most important topics concerning PCOS patients is the question of “insulin resistance” as being the main cause of polycystic ovarian syndrome.
The basic problem with PCOS (polycystic ovarian syndrome) is that the ovary does not function correctly and therefore does not ovulate on a regular basis. The good news is that with the use of fertility drugs, the chance of getting pregnant with polycystic ovarian syndrome is very good.  A majority of women with polycystic ovarian syndrome will be able to have a baby with fertility treatments such as IUI or IVF. One of the difficulties with PCOS patients is that their ovaries are very difficult to stimulate, so that many (80-85%) do end up proceeding to IVF.
Ovarian hyperstimulation syndrome (OHSS) develops after you take a type of fertility medication that acts directly on your ovaries, stimulating them to produce multiple eggs. In 2010’s January IVF cycle we had a patient with PCOS at our center who had undergone IVF at another clinic in the Bay Area. This may lead to menstrual cycle changes, cystic ovaries, trouble getting pregnant, and other health changes. Many women who are thin and have regular periods are surprised to find they have this syndrome. For those who are not trying to get pregnant, the dominant male hormones have to be suppressed, female hormone needs to be increased and the patient needs to have regular cycles. Therefore, any infertility treatment that you do will require that you take fertility medications in order to induce the ovaries to ovulate.
For young women under age 35 with polycystic ovaries, the real question is more about which treatment will be effective – and not so much whether any treatment can ever work. With the simple medications such as Clomiphene or Letrozole, many PCOS patients do not stimulate at all despite the highest dosages, whereas, with the injectables (gonal-f, Follistim, Bravelle, Menopur), they tend to stimulate too much and produce too many eggs (many of which are immature) necessitating cancellation of the cycle.  This is a situation all patients most certainly would want to avoid!


There she developed severe, life-threatening OHSS, was admitted to the hospital and stayed there for seven days. This is going to be manifest by an elevated fasting insulin blood test, or abnormal glucose tolerance, that is, when the fasting glucose is elevated, a glucose tolerance test is positive or there is a diagnosis of diabetes.
With IUI the goal is to have the patient ovulate three eggs per month (that is what increases the pregnancy chances).
Typically, signs and symptoms of OHSS appear within the first 10 days after a gonadotropin injection, when the ovarian blood vessels have an abnormal reaction to the hormone and begin to leak fluid.
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It is clearly some inherent pathway within the ovary that is dyfunctioning, and it is clear that there are many forms of this disorder.
At the Fertility & Gynecology Center, there is a specific low-dose birth control product that we use which has proven quite effective. In reality, only 30-40% of these women have insulin resistance, and only those patients will have some response. In these cases, the insulin level may be low or normal because the long-standing resistance has caused the pancreas to stop secreting insulin. Ultrasound is then used to gauge her progess and time when the insemination should be performed. This fluid fills the follicles, swells the ovaries and sometimes moves into the abdomen in large amounts. It may be a multi-factorial condition where there is not one presentation or one treatment.
Some will resume normal ovulatory function, and others will respond better to fertility medications.
If a patient is not insulin resistant then Metformin or similar medications are not indicated.


Basically, when the ovulatory follicles reach appropriate ovulatory size (18-24 mms), then a trigger such as HCG is given to trigger ovulation. He has developed a specific medication protocol and monitoring system that is tailored to each patient helping her to ovulate appropriately.
PCOS is one of the leading causes of infertility and there are specific ways to approach this issue as will be discussed below. It is imperative that patients and physicians understand this and not latch onto one treatment modality for all. It will take 6-8 months to see if the medication works and a specific dosage per day is required. There is no cure for PCOS but it can be managed with the help of a skilled, knowledgeable physician like Dr. Ramirez does two IUI’s at 24 and 48 hrs from trigger but some clinics will only do one IUI at 32-26 hrs. Another advantage  of  doing IVF is that it also gives the physician full control over how many embryos are transferred, much of which depends on the age of the patient. There are pros and cons of each and but he believes that two IUI’s are better despite the fact that studies have shown that they are equivalent. With natural treatments like IUI we don’t allow more than three ovulatory sized follicles because we cannot control how many get to the uterus, which would increase the risk of a super-multiple such as 5, 6 or 8 implanting.
If the patient does not achieve pregnancy by four attempts, then the pregnancy rates decrease dramatically so it is recommended to proceed to IVF from there.



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