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  1. #1
    michelle28
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    Preventing miscarriage in women with PCOS

    Hi, I am new to the site. I was diagnosed with PCOS 3.5 years ago, and have tried metformin on and off for several years. I have some symptoms of PCOS--the facial hair and cysts on my ovaries but am not insulin resistant and the only hormonal abnormality is high DHEA levels. When my husband and I got married in October, we decided not to try to prevent pregnancy because of the possibility of having a difficult time conceiving. We were thrilled last month when I found out I was pregnant. I miscarried last week--at 6.5 weeks pregnant. I have been doing quite a bit of research and have found that miscarriage is common in women with PCOS. We want to try again in a month or two, but I am scared that I will miscarry again--and I am not sure how I would deal with that. This miscarriage was devastating. I am wondering whether there is any information on preventing miscarriage in women with PCOS besides treatment with metformin. I don't want to use that during pregnancy, especially because I am not IR.

    Does anyone have any ideas or experience with this particular issue?

    Thanks.

    Michelle


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  3. #2
    eaglet
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    Michelle - I'm very sorry about your loss.

    I do not know of any methods of preventing m/c caused by pcos specifically, other than metformin. I don't necessarily agree that metformin can't help those with pcos who are not IR. For one thing, IR is notoriously difficult to diagnose (a fasting level is not enough). But, there's more to it, and I don't think I can explain it. You've probably already seen these sites, but look at http://www.health-alliance.com/jewis...k/polycyst.htm and maybe
    http://repro-med.net/papers/pcos.php . I think that Glueck's studies do not differentiate between those pcos'ers who are clinically IR and those who are not (but check - I can't remember and I haven't read through them in a long time). His report says that metformin "reduces first trimester miscarriage from 45% to 9% in women with PCOS, and lowers PAI-Fx, testosterone, and androstenedione, proably accounting for its ability to be protective during pregnancy in women with PCOS." What I am trying to say is that there may be more involved than just insulin.

    I am not clinically IR, but I took it until week 13 of my twin pg (which was successful). I also have some other issues - clotting and immune issues - which were treated with heparin and IVIg during that pg - i.e., it's not possible to separate out all my problems and say what worked and what didn't. But, for me, I don't have any qualms about taking metformin during pg. I am hoping to do it again if we're lucky enough to conceive again.

    If you want to read more about causes of m/c other than pcos (it's always possible to have more than one problem!) a good place to start is http://www.haveababy.com/rpl/causes.asp (also click over to the treatment section, etc.). There's also http://repro-med.net/info/cat.php and http://www.rialab.com/pages/ria2.html .

    Continuing metformin is certainly a tricky decision. My own endocrinologist, for one, does not feel comfortable prescribing it during pregnancy, though my reproductive immunologist does. You have to do what is right for you. With your history, you need to consider the metformin issue carefully. Other than that, there's the option to get tested for the pg loss issues described on the websites above (I've done it; visit the immune boards for further info). If you ever suffer another m/c (I pray not!), you might want to consider getting the products of conception tested to verify whether a chromosomal abnormality was involved or not.

    I don't know if this gives you any additional info that you didn't already have. Wish I had more answers. Please keep us updated!!
    -eaglet


  4. #3
    michelle28
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    Thanks so much for the information and resources. I have been checking them out and will be consulting with my doctor as well for possibilities. I just wanted to say I appreciate your input and resources.

    Michelle


  5. #4
    PGDMommy2be
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    Michelle,

    I am so sorry about your recent m/c (HUGS) I too have suffered 2 losses (13 wks & 11wks) It was devestating to say the least. Both were due to chromosone abnormalities. I'm young (was 22 @ the time) and was told it was
    so rare (blah blah blah) I think most dr's don't have a clue about pcos, IMO.

    With my next pg I took Metformin, I had never taken it in the past because 2 former ob's of mine dismissed the fact I could have pcos because (I'm thin).

    Well Finally my RE was able to DX me and The next pg was great. I was actually told to continue to take the Metformin thru 13 wks pg.
    It lowers to m/c rate a ton. Good luck to you!

    -PGDMommy
    Clomid miracle '00
    M/C#1 Baby boy 3'02 @13wks & M/C #2 baby girl 12'02 @11wks Both sadly lost to Triploidy
    IVF/ICSI/PGD#1 = Miracle '04
    Loss#3 6'05 FET/PGD#1 Chemical
    IVF/ICSI #2= TWIN Girls!! Born 35w4d 2006
    Natural Miracle 2008


    "Sometimes the Miracle you pray for is NOT the miracle you may recieve"


  6. #5
    bayoubaby1
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    Progesterone is also a huge help for people with PCOS during pregnancy. I take Fortamet for PCOS and will continue taking it throughout my first and second trimester. Studies have not shown any problems, and my doctor keeps people on it so that they will have their hormones regulated and will deliver and not miscarry. I trust him very much, and I would do almost anything to prevent a m/c again after what I have been through. I wish you the best with whatever you decide.
    IVF/ICSI #1 Chance Ian:4-5-06
    Our little miracle:
    http://chanceian.blogspot.com/

    Each day as I watch you struggle I am reminded to find joy in the little things, to stop and smell the flowers, and that some things are more important than material things. Your smile melts my heart, and takes the chronic pain away, if only for a fleeting moment. Thank you for the joy that you bring, my son.


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    Sky&Dal+Ry
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    Hi Michelle

    I'm lurking here as I found this msg listed on most recent msgs...anyway I just wanted to say first of all I'm really sorry for your loss. I've suffered 2 early m/c's and lost my little girl in my 20th week due to PROM. After my 2nd m/c I went to a RE and was diagnosed with PCOS and R ovary failure. My 2 early m/c were due to low progesterone. After working up to 250 mg clomid on a monitored cycle and HCG injection, once again became pg. Progesterone once again on the low side, 13.2. This time I was immediately put on crinone, which is a form of progesterone, and a baby aspirin per day. I was on crinone until my 12th wk and baby aspirin entire pg.

    I don't know if there's any way to prevent a m/c, but I'd definitely ask for a progesterone test to monitor those levels. Hugs and good luck to you

    ________________
    Jackie


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    mmi
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    I have mild pcos and am not insulin resistant...... m/c twice.... was on a baby aspirin both times. So for my third pregnancy, I used the baby aspirin(81mg at bedtime from beginning of cycle), glucophage 1000mg(from beginning of cycle) AND progesterone suppositories from ovulation on, even though my progesterone blood levels "seemed" normal(or as soon as you know you are pregnant). I was seeing a RE at the time. I did carry my next 2 pregnancies successfully!! so I really believe in this combo. I know m/c are so hard.... but the prize at the end of pregnancy is so worth it. good luck.
    3 years and 15 medicated cycles(clomid, injections, iui's, ivf's, fet, you name it) and 2 angels before finally getting princess 1 (1999)

    2 injection cycles for princess 2(2002)
    Truly miracles!

    "Life isn't measured by the number of breaths we take, but by the moments that take our breath away."


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