If there’s a negative reaction with ovulation induction, maybe menopausal shots could help!
“Doctor, I have PCOS, and the last two IUI treatments I’ve only managed to acquire one or two eggs, can I still do IUI?”
PCOS? Negative reaction with ovulation pills?
I did an ultrasound and made sure her ovaries still had a decent amount of eggs, around 20 each. I told this 30-something-year-old, “Let’s try needle injections. If the effects are negative, then the success rates won’t be ideal either; we’ll at most do IUI, not IVF.”
Due to an irregular cycle, I prescribed her an aphrodisiac to do injections during her period. And unfortunately, there were only 1 to 2 follicles, leading to an unsuccessful IUI treatment. In other cases, increasing the needle injections results in a better outcome, yet for this patient, her follicles remained at 1 to 2 each time, and repeatedly failed IUI treatments.
What do we do?
There’s little to close to nothing in terms of medical papers on negative reactions from PCOS. For two months, I racked my brain for solutions, even while driving.
The weird thing is, there’s a lot of basal follicle counts in her ovaries, but they were unable to grow even under medication and injections, so if we do the opposite and give her menopausal injections, will that help? I decided to work the opposite way, and told her I wanted to give her menopausal injections for 3 months, then do ovulation injections. After two months, she told me she wanted to try ovulation induction. I thought, technically it’s worked already, and if the reaction is still negative, we’d at most do IUI, not IVF.
But this time, it was a completely different outcome, we got over 10 follicles, and proceeded with IVF.
She thought it was unbelievable! Why didn’t anyone else think of this sooner?
After two months, we defrosted 2 blastocysts, and successfully conceived with two embryos!
These two embryos were a bit close, with a thin film less than 2 mm between them.
They’re identical twins!
Although, there’s still a 30-40% chance that identical twins could develop a condition called “Twin-to-Twin Transfusion Syndrome,” or TTTS that could potentially hinder their growth, specifically neurological aftereffects. To prevent this from happening and potentially catch it earlier, I transferred to the medical center. Yet, there were no risks, and out came a set of adorable twins. Twins who often do the same thing at the same time.
Conclusion:
Not all PCOS symptoms respond well to ovulation injections. Clinically, there are no studies yet as to why there is near zero response. There’s currently 2 possibilities: that AMH inhibits the follicles response of FSH, or that the follicles’ FSH receptors are insufficient.
When ovarian function is sufficient (AMH & AGFC), yet unable to retrieve 6 follicles, we won’t suggest IVF since the success rate is low.
Whether the reaction is positive or negative, we can only find out through needle injections, not blood tests or ultrasounds.
To have a successful pregnancy, sometimes we need to think outside the box.
