Desperately need advice!

[u/cassanderella10]

Hey everyone!

I am trying to conceive and desperately seeking any and all advice you’re able to give me. Background info; I am 28F and was diagnosed with PCOS/PMOS when I was only 13 years old. I was on birth control for 14 years and only really had a few months here and there where I would stop taking it for a while to see how my body would react and it never lasted too long because I simply do not have a period naturally. I have been off my birth control since beginning of May and so far my symptoms aren’t too bad, but I still have not had a period naturally. My OB started me on Provera to force a period, then 5.0mg of Letrozole. That stared off promising because my ovulation test strips were coming back as positive for ovulation, but I never saw a surge in LH so my OB did a blood test on CD 23 and my progesterone level came back at only 0.6 ng/mL. Naturally, this was very discouraging for me since that it absolutely no where near the level needed for a confirmed ovulation. I took pregnancy test a few days ago and it was negative. I figured it would be, but a part of me still had hope 😔

So, here I am asking for all the help I can possible get to get! What worked for you? What didn’t? Did your progesterone finally spike?

My husband and I cannot afford IVF and my OB said if I’m not pregnant after 6 months from just Letrozole that I will need to seek other treatment options. But like I said, we just can’t afford that so this is really our only shot.

What I’ve already tried/going to try:
• 5mg letrozole
• Myo-inositol and D-chiro-inositol
• Inito fertility tracker
• Prenatal vitamins

[u/FoxNFern]

So I have a different experience than most. My OB handled my fertility and did an absolutely amazing job.

We started with a full workup, bloodwork, ultrasound, etc. I had to get some polyps removed and we wanted to do a D&C to prep with new lining because I hadn’t had a period in years.

From there we moved into Letrozole. I started out at 2.5mg that didn’t do anything, did two rounds of 5mg and while I did ovulate, it wasn’t a strong ovulation, then two rounds of 7.5mg and we were successful on the second round of 7.5mg. With my second who I’m currently pregnant with it was first round on 7.5mg and my body knew lol.

I tracked with the Mira analyzer. I think Inito is similar. Keep in mind that while “most” people ovulate CD14, not everyone does. I usually ovulated CD 18-22. Which means at CD23 I wouldn’t have had a PdG spike yet. I know some women can also have naturally high LH which can make it difficult to detect a surge. Some suggest BBT or CM as alternative ways of monitoring ovulation. Those didn’t quite work for me, but I was able to use LH strips.

I’d ask your OB about going up to the next dose. It may also be worth asking about Clomid if the increased dose doesn’t help. My BFF also has PCOS and had to be on Clomid because Letrozole didn’t work for her. I’ve heard of some doctors who do a mix of Letrozole & Clomid. Sometimes they do trigger injections as well. There are other options before IVF.

I’d also say the first failed cycle isn’t super alarming. Most women average 3 cycles on the correct dose before they are successfully. Wishing you all the best luck!!

[u/Sorrymomlol12]

“That stared off promising because my ovulation test strips were coming back as positive for ovulation”

Oh good!

“but I never saw a surge in LH”

I don’t think you know what those first words mean, because these are a direct contradiction. Two lines on an ovulation test is not positive for ovulation, two EXTREMELY DARK lines is a positive test. Anything else is negative (one dark line one faint line is a negative test. There are not like pregnancy tests).

“so my OB did a blood test on CD 23 and my progesterone level came back at only 0.6 ng/mL.”

This is evidence that you are not ovulating at all, not that you don’t have high enough progesterone. You cannot get pregnant if you are not ovulating.

Here is a link with a bunch of information that will be super helpful for TTC with LH strips.

https://www.reddit.com/r/PCOS/s/x0IUebt1zq

Continue to take your prenatals and myo/d chiro inositol, but also add baby asprin to your line up. My OB puts absolutely everyone TTC on it as it solves a bunch of clotting issues without actually having to run any expensive tests, there are no downsides, and it’s cheap. “Some folks struggle to conceive and then we put them on baby asprin and they are pregnant quickly after that.”

Are you overweight/obese? IVF might be out of your budget but GLP1s might be possible. I know for me, I only have 1-4 periods a year with unknown ovulation, unless I use GLP1s to lose weight. Then my periods return to perfect 28 day cycles with confirmed ovulation. No ovulation meds necessary! The going rate right now is $83/month. My husband and I considered this a joint expense for our fertility.

I have a 9 month old and am currently pregnant with baby #2

[u/cassanderella10 → u/Sorrymomlol12]

Hi! Thank you for your advice! I will definitely try the baby aspirin. I have not heard of that before ☺️

For the ovulation strips, you can certainly test “positive” without having a confirmed ovulation. The LH strips are JUST testing for LH levels, but ovulation has lots of hormones that are involved. That’s why I’m going to test with Inito because that will test all of the hormones. So even though my LH strips were coming back positive, my progesterone levels were basically non existent so I definitely did not ovulate.

[u/Sorrymomlol12 → u/cassanderella10]

Inito is a good option if the LH strips are confusing you!

I just wanna be clear for anyone else reading this, two lines on an ovulation test is NOT positive. Ovulation test are only positive if both lines are incredibly dark, which from your post did not happen. Meaning you got no positive ovulation tests which makes sense because you were not ovulating.

For example, everything in this photo is negative except for the 2 dark tests. Two lines alone is not positive. Even a few days prior where they are close to the same darkness is not positive.

https://www.reddit.com/r/BrandNewSentence/s/YNg2ZW1mIK

The other link I first referenced I would read again because I do highlight that a positive test is not indicative of ovulation, but you also said you never got a surge in LH in your post, meaning you never got a positive, never got a dye stealer, and yes didn’t ovulate.

And yes while a dye stealer isn’t indicative of ovulation, it’s a very very good sign that you did. I also highlight in that first link that if you aren’t getting a dye stealer then you will hallucinate a positive with the darkest test you can find.

I’m not trying to be pedantic but people get this confused all the time and think all their tests are positive because of the two tests and they just aren’t. They need to be absolute dye stealers, and if they are only “sorta close to a dye stealer” it’s probs not ovulation.

Inito will solve all this confusion though because they track progesterone! Best of luck!

[u/cassanderella10 → u/Sorrymomlol12]

True! I was using the clear blue digital version where you get a smiley face when they detect ovulation so it was DEFINITELY confusing me lol! Inito to the rescue 🫡

[u/danarexasaurus]

I would skip the OB and go straight to a Reproductive endo. If your issue is that you don’t ovulate; they’ll give you meds that make sure you do. And they’ll monitor to make sure make sure you’re not making too many mature eggs (more of an issue with Clomid for those who don’t ovulate using letrozole).

[u/Diseasedansari9]

In a similar boat. Also doing 2000mg metformin. And did an ovulation trigger shot with letrozole this month unsuccessfully. I also use inito and supplements. I’m going to try again with potentially clomid or higher letrozole

[u/Malloraaay]

I usually take pioglitazone to help regulate my cycles and this time the letrozole helped balance my estrogen and progesterone

[u/AB_1204-]

Will you be able to do a monitored TI?

[u/cassanderella10 → u/AB_1204-]

My OB doesn’t want to do that yet… she wants to see how I do after this next cycle

[u/Itchy-Site-11 → u/cassanderella10]

You need a RE and not an OB

[u/ResponsibleRead567]

I don't ovulate on my own, despite being normal BMI and taking all the supplements and eating "well", so my case is a bit niche.

I also didn't ovulate on just a letrozole cycle, so I take low dose stimms (37.5 menopur) twice during the cycle. They monitor the follicle growth and then I take a trigger shot when the follicles are mature. Currently on cycle three after a CP on the first.

[u/rustypotatooooooooo]

I know you say you can't afford treatment but not all treatment is expensive. Depending which country you're in I highly recommend you try and find a Napro/Creighton practionioner or someone who does Restorative Reproductive Medicine (they're sort of inter changeable). They will have you chart and treat you with medication which will mostly be covered (again, depending where you are - in Canada I pay very little out of pocket for meds, though the consulting fee is like $300 which is nothing compared to the IUI/IVF route).

[u/Friendly-Presence590]

What worked for me was being on GLP-1s for 7 months and losing 60 lbs. Have sex when you notice EWCM.

[u/r_eva1234]

I know people shit on it but going on Metformin was a game changer for me. I had been on 500mg for 2 years and after progressively increasing it to 2000mg, my periods dropped from 42 days to 33 days. This was in combination with other lifestyle changes I'd already had in place like regular exercise (walking, yoga, low impact strength training), taking 2 cups of spearmint tea daily (~3000mg), taking the 4100mg myo + d-chiro inositol, and a bunch of other supplements like vitamin d, zinc, omega 3.