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Infertility Cubby

PCOS Genetics and Therapy
By Sam Thatcher, MD, Ph.D.

Sam Thatcher, MD, Ph.D.Q. I was diagnosed with PCOS several years ago. I have many classic symptoms - weight gain, excess hair, insulin resistance, annovular periods etc. My OB suspects that I have always had it but that the development of the symptoms was triggered off by my first pregnancy, as until then, I had no symptoms other than irregular periods. I have three children, the last of which required clomid to induce ovulation as I have had less than a period a year since the birth of my second son 5 years ago. With each pregnancy my symptoms get worse. I guess I have several questions - is it likely that my PCOS is indeed getting worse with each pregnancy? Is there any alternative to drugs (eg metformin) to control it? We are wishing to get pregnant with our last child but I am reacting negatively to the clomid dose required to induce ovulation (50 mg). So are there alternatives to this? As I am now 33. We wish to conceive fairly quickly - is there anything else we can do? And possibly most importantly - my mother is into alternative medicine and has suggested that I could restore my cycles with the use of 'natural' progesterone cream as suggested by Dr John R. Lee. What are your thoughts? I would appreciate any answers you could give me.

A. I would agree with your OB that you may have always had PCOS. It is a genetically based disorder. I am not sure about whether it was your pregnancy, or equally likely was that it was age and often weight that brings PCOS to the surface. Since PCOS can be altered by environment, I would strongly suggest that you encourage the very healthiest lifestyle in your children. They may not be able to escape the gene(s), but it is possible to alter their consequences by the changing the environment. Hopefully this indirectly answers a part of your questions.

I would concentrate on establishing and maintaining the healthiest possible lifestyle. Maximize nutrition (without dieting); increase physical activity without stressing yourself. Small investments can pay major dividends.

Metformin may be a good alternative, especially since you state that you are insulin resistant.

I am very cautious about recommending supplements. It is not that they may not work, in fact, it is that I have too much respect for them to idly prescribe herbs and supplements without a firmer scientific basis of their positive actions, and most importantly possible negative actions.

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