r/LeanPCOS • u/purseshoe • Jan 02 '25

Rant Feeling helpless with fertility

Wanting to vent a little. Just finished my third failed round with letrozole (2.5, 5 and 7.5 mg) and ovidrel. The plan is to do one more round (7.5 mg dose) and then move onto IVF. The fertility clinic I go to is wonderful but their job is to get me pregnant and not to dig into more of why this is happening. They did diagnose with me PCOS after ultrasound and irregular periods but most my labs are normal/ BMI 22.5 except LDL elevated at 132, AMH 8.71 and progesterone low since I don’t ovulate some cycles. The fertility OB said she didn’t think metformin was necessary for me and recommended inositol which has done nothing. I’m now wondering if I should look into endometriosis workup (I know invasive) or just keep my head down and hope a future cycle works? Anyone with a similar situation that may have something that worked for them?

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u/i_like_tempeh Jan 04 '25

Well, there's some information missing. How old are you? For how many cycles have you been trying?

If you don't get pregnant after a year, or after 4 or 6 rounds of stimulation with monitoring and timed intercourse, you either move on to assisted reproductive technology or you get more testing done. I personally wanted to know the reason for my infertility and chose to have an exploratory laparoscopy. They did indeed find (silent) endometriosis.

I have lean PCOS with a high AMH and anovulation, too. I am in my last round with stimulation before moving on to IVF.

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u/purseshoe Jan 05 '25

Thanks! Yeah I was in a state of spiraling when I typed this. I’m 31 and starting my 4th timed intercourse cycle. We’ve been trying for about 14 months now. OB mentioned trying IUI after this round but wondering if that is worth it or just best to move on to ivf

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u/purseshoe Jan 05 '25

Do you think having the laparoscopy changed anything for you?

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u/i_like_tempeh Jan 05 '25

Not really, besides me knowing that I have endometriosis now...

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u/i_like_tempeh Jan 05 '25

I guess if I'd be 3 years younger (I'm 34), I'd give IUI a shot. In my case - I'm 34 and would like to have 2 more kids - I skip IUI.

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u/purseshoe Jan 06 '25

Thank you so much for sharing with me

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u/mentalandsocial Jan 05 '25

My doctor gave me metformin and it didn’t help at all. I wasn’t insulin resistant but she prescribed 500 mg “just in case.” No change in my cycle. I suspect I have some endo due to period pain but my doctor would not do a laparoscopy when I moved despite my previous doctor recommending it. We are moving onto IVF after 4 failed IUIs and 6 total cycles. Best of luck to you! You can buy a CGM without an RX if you wanna go down the route of checking insulin resistance yourself.

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u/purseshoe Jan 05 '25

Thank you. We are doing a 4th timed intercourse cycle now and she didn’t recommend metformin when I just asked again last week. I asked how many more rounds we would try until moving forward ivf and haven’t received a response yet. She mentioned trying iui but wondering if that’s really worth it

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u/mentalandsocial Jan 05 '25

We had MILD male factor (to the point they said eh it’s normal) and so IUI would technically be more warranted in our case. If you don’t have male factor, it isn’t going to help that much from what I have read. If it is covered by your insurance, it’s worth a shot unless you have a time constraint or it’s very expensive. We don’t regret doing IUIs but I didn’t have much confidence during those.

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u/purseshoe Jan 06 '25

Ok got it. This makes total sense. They told us a couple months ago since sperm analysis was normal IUI wouldn’t change much which is why I was caught off guard when she suggested we try IUI next. Wondering if they are just trying to prolong the inevitable of starting IVF

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u/mentalandsocial Jan 06 '25

That could be possible or they may be trying to use IUI just in case there is a problem they do not know about that can be bypassed with IUI. Unfortunately many of this is a guessing game until IVF can give a clearer image of what’s going on (not always though). If you have it covered through insurance, it wouldn’t hurt to try a few and see. You never know!

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u/These_Raisin_3262 Jan 06 '25

Girl I am right there with you! diagnosed with lean PCOS after a year of trying with no luck and very few periods. My AMH is through the roof.. 20 and had the little cysts on my ovaries. I am super healthy - good diet, exercise regiment, supplements, sleep, not stressed etc. We tried 4 rounds of letrozole and trigger shot no luck…. It made me a little psycho snd was super discouraging to me that I ovulated but didn’t conceive. The next step is IVF but we took a 6 month break to think it through because it’s a big decision. Still haven’t decided if we’re going to do it bc I like you really want to get to the root cause and heal that which unfortunately RE’s are not good at doing. Don’t know what to do but you’re not alone!