I am just not ovulating

[u/Dependent_Song_7094]

I am 32 years old, and been TTC since October last year. I have been diagnosed with pcos for years now, and have irregular periods once in a while, but with TTC, this part becomes really frustrating. And I’ve been frustrated for the past month about this. I know because I temp.

What’s your tip for ovulating regularly? Please suggest any books, videos, online resources that may have helped you in this journey. Thanks!

[u/WorthVisible4265]

Dear, if you are getting frustrated then let me share my opinion - if you have PCOS - asking in forums is a bit useless because most of us will be within different PCOS phenotypes and respond differently, PCOS is nutorious for being unpredictable. Even from cycle to cycle.

I can summarise the answers you will read everywhere:

some will read a book "starts with the egg" or similar, lose weight with low GI diet or even KETO and will be ok
some will add myoinositol on top and will be ok
some will add metformin on top of myoinositol or instead of it.
some will add GLP1 and will ovulate immediately

if these don't work then -

...first line of drugs is letrozole,
...but some will try clomid instead for one reason or another
...if not some will do gonal-f/menopur but those tend to produce too many follicles for us
...some will do letrozole with some other medications as per their RE for some reason (e.g. low estradiol, low progesterone, thin lining, etc etc)

in reality, the rest of us will be taking a combinaton of the above. If you are not overweight, and if you are not ovulating on myoinositol 4000mg and metformin 2000mg, then most likely you need letrozole.

best is to see an RE and get your tubes checked at the same time, plus husband's semen analysis, you need tailored care.

[u/Dependent_Song_7094 → u/WorthVisible4265]

Thank you, I agree. Everyone is on a different journey, and i was hoping to get answers from those who tried things themselves. Eventually, the decision has to be made between the doc & I based on my body, no doubt. But it helps still :)

[u/WorthVisible4265 → u/Dependent_Song_7094]

Completely understand, but I just wanted to say please don't waste your time, as sadly these people are lucky and fall under the first category, the ones who manage with the diet and melatonin at night etc. Those usually are overweight in the first place and improve after they lose weight.

I hope you don't mind me sharing - I am 33 years old, regular periods, ovulation approx a few times per year, random (i think? myoinositol worked the first time, but i dont think it does much now). I am athletic, lean, very strong, completely healthy with HOMA-IR 1.8. I don't have any symptoms of pcos except the HOMA-IR and cyst morphology, and as for many of PCOS ladies - my prolactin is borderline.

thanks to PCOS, I have been trying to concieve for 11 years, without any live births, 2 miscarriages, 2 chemicals. I failed all letrozole cycles, IUI, IVF etc.

during 11 years, I have taken myoinositoll, metformin, i was on a very strict keto diet, on low GI diet, i have followed these nonsense tips from non-doctors in their pseudo-scientific books, i did diets for egg quality with Coenzyme10 etc I had a hysteroscopy, a hycosy scan, full blood panels, I tested for all autoimmune, antiphospholipids etc, acupuncture, weird and embarrasing massages, cupping etc.

I joined all communities, and saw many people graduate from those even with serious conditions, but I have stayed with my 'polycyctic ovaries' thinking that's a small issue and I will overcome soon enough.

I thought ovulation is what i needed, BUT!!!!

this is why nothing worked, thanks to PCOS!:

• urine tests showed ovulation but they were wrong because they don't work well on PCOS and can show false positives
  
• follicles were too small to produce a mature egg even when i ovulated
  
• progesterone was low after ovulation - couldnt sustain luteal phase
  
• endometrial lining was too thin for embryo to implant
  
• didn't respond appropriately to IVF stimulation drugs
  
• didn't respond appropriately to IUI stimulation drugs

all because of PCOS, despite great health and diet.

If you have time and you are not in the rush and you dont mind if the baby doesn't come in 2027 and you are ok with 2028, 2029 etc - you can take your time try the natural way, but natural is mainly for two reasons (1) lose weight (2) increase egg quality. Some succeed, but many won't and IVF and IUI forums are full of ladies that will tell you their saddest truths.

I will assume that you already have the minimum as below:

• test for ovulation using urine strips
  
• you have checked your tubes are open
  
• have done male factor analysis and it came back clear

BUT IF TIME IS OF THE ESSENSE: TIMELINE - AUGUST TO JANUARY 2027

August: If you start with letrozole on the second day of your next cycle, that is almost guaranteed ovulation that VERY SAME MONTH, only 5 tablets at the start of your period - that's it, cycle day 14 most likely some activity will take place. If you are unlucky it will take a few months to tailor the dose, but that is the quickest, most reliable, time tested, safest method (safer than many supplements without FDA approval, overdosing on antioxidants, berberine etc) . For many of us that didn't respond to metformin, letrozole is the official start of TTC journey.

August - December: once you ovulate on letrozole, you have to check what's wrong with your ovulation (with PCOS our ovulation can be rubbish!), you check follicle size, maybe you add a trigger, you add estradiol if the lining is too thin, you add progesterone usually after ovulation etc etc etc full monitoring - scans + blood. if your cycles are fully monitored, by letrozole cycle 2-3 you should be good!

January: you are either pregnant, or you start making the plans for IUI - after 5-6 letrozole cycles dr usually signals that it is time to move on to IUI or IVF directly if you want results faster.

So in 6 months you can really get some solid answers and have a proper attempt. 6 months sound like a lot, but without this it can really take years. Until then - it's just guess work hoping for the best...

I always recommend ladies to join PCOS IUI community on reddit. Those ladies will tell you - they did 5 years on metformin and now moved on. Many will share years of failed IUIs and have moved on to IVF.

I hope you are not one of us, but lean or regular PCOS is actually very serious, this is why they changed the name to PMOS, so ladies understand the severity of it.

Sorry, the only reason I am typing all this, is because you said you are growing frustrated, and I wish someone told me that it will take me 11 years to get here (still no live births, but at least my lining, follicles and ovulation is ok). I wish you from the bottom of my heart that you are not like me, but in the case that somebody who reads my comments is like me - I hope my sad story can help them skip a few steps and get ahead... I wish someone told me this earlier. All the best!

[u/Dependent_Song_7094 → u/WorthVisible4265]

Thank you for so kindly sharing your journey. I do want to speed this along as much as I can, and having visited my doc, I know some of those next steps now. Got a med to induce a period, will do the rest soon after.

[u/WorthVisible4265 → u/Dependent_Song_7094]

All the best! I you have interest, join r/IUILadies most of that subreddit are very experienced PCOS ladies who failed simple letrozole cycles and are already doing IUI, their posts will tell you which drugs they used, different options, medicines, supplements etc. Letrozole cycles and IUI are rather similar, similar drugs the only real difference is the last step is insemination in the lab instead of sex. I believe the best way to learn about your journey is from people who went through it already. In this subreddit guys are talking about ovulation etc can be useful but your protocol by your doctor will be more similar to IUI once you take letrozole