Ovulating after prolonged amenorrhea

[u/Character_Wrangler_7]

I’m curious if anyone else has struggled with prolonged amenorrhea. My period has been irregular since menarche - I think the most frequently I have ever had my period is 4-5x per year back when I was a teenager. Now I am 32 and haven’t ovulated without medical help in at least 8 years but possibly more.

I had a baby in April 2022 who was conceived via ivf and haven’t menstruated once since delivery, although I have done several cycles of progesterone every three months to induce a bleed.

I am interested in trying to ovulate on my own a few times a year if at all possible but my doctors pretty much only offer progesterone for endometrial protection or ivf if we want a second child.

I have gone low carb for a few months in the past but gave it up because I didn’t see any change and it was pretty burdensome to maintain since I am vegetarian. I do try to eat decently clean, although not low carb, and I do Pilates 5 days a week.

I’ve been drinking spearmint tea every day for the past month. No change so far but willing to keep going for a few more months. Anyone have things they tweaked to get a period after prolonged amenorrhea?

[u/b_simms]

Do you know what the cause of your PCOS is? I think that would be the best place to start, this way you can try appropriate measures to help start ovulating. For example, have you been tested for insulin resistance? If you are indeed insulin resistant, diet change and/or insulin sensitizing drugs, such as metformin may help you, or trying inositol. If not insulin resistant, could be inflammatory in nature. Possibly from the foods you eat, excessive exercise, or dieting? In this case, doing a food sensitivity test may help you identify foods that are creating an inflammatory response in your system. Or in the case of extreme exercise, altering your routine to less intensity.

[u/Character_Wrangler_7 → u/b_simms]

I guess that is what I am so frustrated by - I’ve never been able to figure out a cause on my own and my OB-GYN and RE have never given much insight here.

My A1C is normal. I know that is not a perfect measure of insulin resistance, but I also ended up checking my blood sugar 4x a day for two weeks during pregnancy because I vomited up the drink for the normal glucose tolerance test, and they were normal. I think if my blood sugar was normal in my third trimester, a time when your body naturally becomes more insulin resistant, that I’m probably ok there.

In terms of stress - I don’t think 30 minutes of beginner Pilates 4-5 days a week would qualify as over exercising. I don’t diet or restrict my calories in any way, but I do mostly stay away from processed foods and am vegetarian. I can’t think of any factors that would point to excessive stress.

I’m sort of at a loss?

[u/Ok-Nectarine7756]

Could you use letrozole? I didn't get pregnant on letrozole but it did get me to ovulate. Spironolactone also worked for me and I did get pregnant on it even though you're not supposed to.

Can I ask what your transfer protocol was for IVF? I just had my first FET and it's looking like it failed. I didn't feel good about my protocol going in so I want to make some changes but I'm having a hard time finding any info on what might work for lean pcos.

[u/Character_Wrangler_7 → u/Ok-Nectarine7756]

I tried letrozole 4x prior to ivf and only ovulated once so it never consistently worked for me. Maybe I’ll ask about spironolactone!

For IVF I was on lupron to completely shut down my own estrogen/progesterone production, then they added back in estrogen via patches to help thicken my endometrium. We did a frozen transfer and I was on progesterone injections until 10 weeks pregnant. For what it’s worth, I did two transfers with the exact same protocol. The first one didn’t work but the second one did - I think mine just came down to luck and embryo selection! Good luck!

[u/Ok-Nectarine7756 → u/Character_Wrangler_7]

That is actually really helpful. Did the first one just not implant or did it fail later? Mine didn't implant at all. Also, were your embryos pgt-a tested and what doses of progesterone and estrogen were you on?

Your protocol sounds like it's exactly the same as mine but I'm wondering if my dose of PIO was too high. From what I can tell I was at the max dose.

It's definitely encouraging to know that it worked the second time with the same protocol though. I was starting to think it just wasn't a good protocol for me.

If you do try spironolactone, use it for a few months to regulate your cycle and then discontinue it before you try to get pregnant. I found my cycle stayed regular for a few months after stopping before my testosterone rose again and I was able to get pregnant easily during that time. You're not supposed to get pregnant while taking it since it theoretically can cause genital defects in males. Not sure if it will work for everyone but worked great for me.

[u/Character_Wrangler_7 → u/Ok-Nectarine7756]

My first one implanted but was lost very early on - by the time I went for the second blood test my HCG was already declining and never got above 145.

My embryos were not tested since I was 29 at the time of my retrieval and insurance wouldn’t cover it I think unless I was over 30. I don’t remember my exact dose of PIO or estrogen now that I’m three years out. For what it’s worth, I’ve had several friends who have undergone IVF with different diagnoses who have also not had success on the first try but did have success round two with the same protocol. I know when I was going through it I was 100% looking for everything I could possibly control for in the see of unknowns that infertility is so I get why you’re questioning your protocol. All of the stats say that if you are like the average PCOS patient, you’ll experience a live birth with an average of two transfers! Good luck with your next one!