PCOS

AMH blood test- everything you wanted to know about this common blood test but were afraid to ask

AMH testing, a Q&A: Princeton IVF blog
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Common questions and answers about AMH testing

What is AMH?

Antimullerian hormone, commonly known at AMH, is hormone that is secreted by follicles in the ovary. It was initially studied for its role in reproductive development but is now widely used as a test of ovarian reserve.

What is ovarian reserve?

Ovarian reserve is a measure of the aging of the ovaries, and how many eggs the ovaries are likely to produce when given fertility medications. AMH, day 3 FSH and estradiol levels and antral follicle counts on ultrasound are commonly used measures of ovarian reserve.

What does a low AMH level mean?

A low AMH level, which most doctors consider a level of less than one, indicates that the ovary has fewer eggs available to stimulate. Women with low AMH levels, will usually make fewer eggs when given fertility drugs for IVF or insemination cycles.

Does a low AMH level mean that I am less likely to get pregnant?

AMH is a great test to determine how a woman will respond to medications, but it not as good at predicting pregnancy rates. It is true that women who produce more eggs are more likely to get pregnant, but particularly in young women, who do not need a large number of eggs, there does not seem to be reason to be concerned.

What does a high AMH level mean?

A high AMH level suggests that you are likely to respond very well to fertility injections and may be more likely to become hyperstimulated when taking them. It is also is considered a sign of polycystic ovaries (PCO) although AMH levels are not currently used to make the diagnosis.

Can the AMH level be used to predict if I will have trouble getting pregnant in the future?

Not really. Despite the early hope that AMH could help women know in advance if they might have infertility in the future, it turns out there is no evidence that AMH can predict future fertility.

Should we try Femara first?

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For years clomiphene has been the main medication that fertility doctors and obgyns use to help women with polycystic ovarian syndrome and irregular cycles to get pregnant

That may be starting to change. In fertility practices such as ours, we have switched to a different drug, letrozole, also known by the brand name, Femara.

What is Letrozole?

Letrozole is a medication that blocks an enzyme in the body that converts testosterone into estrogen. It causes the estrogen levels to drop which lead to the pituitary gland to produce more of a hormone called FSH. FSH (follicle stimulating hormone) is the hormone the causes the eggs to start growing. By doing this, letrozole stimulates ovulation The most common use for letrozole is to help women with breast cancer reduce their risk of recurrence.

Why would you want to use letrozole instead of clomid?

Stimulation with letrozole results in fewer eggs than clomiphene, resulting in fewer multiple births. It is also less likely to cause the side effects of hot flashes and mood swings that are common with clomid.

So, what do the experts say about Femara?

The American College of Obstetrics and Gynecologists has endorsed letrozole as first line treatment for women with PCOS and infertility.

 

A spoonful of sugar may may the medicine go down, but will it harm your chances for pregnancy?

Sugary drinks, articifical sweeteners and fertility: Princeton IVF blog
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Recent studies suggests that sugary drinks, even those with artificial sweeteners may harm the chances for pregnancy.

Although it is far from conclusive, several recent studies suggest that sweet drinks may have an adverse effect of a woman's chance for pregnancy, including...

  • Harvard doctors found that drinking one sugary drink a day can lower the success rate of IVF by 12% and more than one sweet drink a day by 16%

  • Brazilian researchers found that consuming sugary or artificially sweetened drinks reduced embryo quality and the chances for an embryo to implant. interestingly

Interestingly this effect did not occur with unsweetened coffee.

The reason for this is not totally clear, though we know both obesity and polycystic ovarian syndrome (PCOS), which are both associated with infertility and miscarriage, and associated with changes in how the body handles sugar, can lower the chances for pregnancy.

So, what should I do?

It is a good idea to keep sugary products to a minimum when you are trying to get pregnant, and to minimize artificial sweeteners such as Splenda, Equal or Sweet-and-Low. These sugar substitutes may be just as harmful as sugar itself.

Don't panic. Women who use artificial sweeteners and drink sweet drinks still get pregnant all the time, even if the chances are a little lower. There are many factors that go into your fertility, so it is far from clear that consuming these drinks is actually harms your chances for pregnancy.

Delaying the diagnosis of PCOS

PCOS may take years to diagnose: Princeton IVF blog
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How long to does it take to be diagnosed polycystic ovarian syndrome?

Apparently a lot longer than you might expect...

A recent study from University of Pennsylvania suggests that women with Polycystic Ovarian Syndrome may not receive the proper diagnosis for years.

Women across the US and Europe were surveyed and this is what the researchers found:

  • in 1/3 of women, it took at least 2 years to make the diagnosis
  • almost of half of women had visited at least 3 health care providers before the diagnosis was made
  • 84 % of women did not believe they received enough information about PCOS at the time of their diagnosis

As a Reproductive Endocrinologist, this is both surprising and not expected.

In our practice, as in most fertility and gynecology practices, PCOS is one of the most common disorders that we see. It is the most common hormonal disorder in women of reproductive age and the ovulation problems associated with PCOS are the most common cause for infertility in women. So, as specialists, we are attuned to look for polycystic ovary, and are more likely to find it in its more subtle forms. We are also committed to educate our patients about their condition, what causes it, how it is treated and what other health implications it might have.

It is also very common for us to see women who were never told by their doctor that they might have PCOS, and only came to see us because they cannot conceive. Still others, looked up their symptoms online, realized they had PCOS and referred themselves.

Sometimes seeing a specialist can help.

Most of the time your OBGYN, midwife or even primary care physician can manage the symptoms of PCOS. If your symptoms are under control and have a good understanding of your condition, there is no reason to seek out help. If your symptoms not controlled, you are having trouble getting pregnant or you don't feel you have an adequate understanding of PCOS, seeing a sub specialist in Reproductive Medicine may be a good idea. 

 

 

Red wine, Resveratrol and PCOS

Could a chemical in red wine help you if you have PCOS: Princeton IVF blog

Could one of the compounds found in red wine help women with PCOS?

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Yes, it actually might help women with polycystic ovarian syndrome.

What is resveratrol?

Reservatrol belongs to a group of chemicals call polyphenols which are commonly thought to act as antioxidants. It is found in the skin of grapes, as well is in peanuts and some berries. Most resveratrol supplements sold in the US, actually come from a plant grown in Asia, rather than from grapes. It has been used as a supplement to help inflammation and diabetes.

Why might resveratrol be helpful for with PCOS?

Polycystic ovarian syndrome is the most common hormone disorder in women of reproductive age, and a common cause for infertility. The symptoms of PCOS are largely related to irregular cycles and excess levels of male-like hormones, but the underlying cause is related to how the body handles sugars. Most women with PCOS have a condition called insulin resistance as the reason for their disorder, and diabetes drugs such as Metformin are commonly used as treatment.  Since resveratol can help women with diabetes, it is possible that it may help women with PCOS as well.

A new study suggests resveratrol may be helpful.

Researchers at University of California- San Diego took women with confirmed PCOS and gave them resveratol supplements to see what would happen. They found that these patient's levels of male hormone including testosterone dropped significantly, suggesting that resveratrol may be doing this by reducing insulin resistance. The researchers did not look at whether their cycles became more irregular or more fertility.

So, should I start drinking red wine if I have PCOS and want to get pregnant?

Not a great idea, at least when you are or might be pregnant. It is possible (but still unproven at this time) that resveratrol may help promote fertility in women with PCOS. On the other hand, it is well known that alcohol, including red wine, when consumed by pregnant women can increase the risk of serious birth defects. It may be reasonable to have red wine before conception, but no OBGYN or  Fertility Specialist would recommend you drink once you might be pregnant.