Dear Dr Rainford,

I read your article in The Gleaner's Health section on April 8 about polycystic ovarian syndrome (PCOS). I started having irregular periods at age 24 and was diagnosed with PCOS. I was on contraceptives for a few years to regularise my period and was then put on Provera pill which worked well but after a while my period would not stop. I would still have spotting, so the doctor prescribed Avandia. So I was taking for four years the Provera to bring on my period and Avandia to stop it.

I am now 33 years old, I have not been on any contraceptive since I got married and I have still not conceived. My doctor put me on clomiphene pill for four months and I'm through taking it and still nothing is happening. He will run further tests if I am still not ovulating and he also told my partner to do a semen test to see if his sperm count.

I know my doctor is good and is advising me the right way but can you give me some advice on the dos and don'ts that will help me to conceive.

— Want to conceive

Dear Reader,

Thanks for sharing your plight. I am sure that many women with PCOS can identify with some of your experiences. As I mentioned in my previous article, women with PCOS do not ovulate on a regular basis and there is an imbalance of the hormones oestrogen and progesterone.

Progesterone increases after ovulation. Provera is a progestin that is sometimes used as a substitute when the body does not make enough progesterone. It can be used to induce a period if a non-pregnant woman has missed menses as in your case, or it is sometimes used to control abnormal bleeding.

Insulin resistance

Avandia, rosiglitazone, is a medication that is usually used to treat diabetes. Since women with PCOS tend to have insulin resistance, this and other drugs used to treat diabetes, like metformin, have been used in women such as yourself. Avandia like metformin has been shown to be effective in helping women to ovulate and improve their ability to become pregnant.

Clomiphene (Clomid) is a fertility drug that is also used to help women to ovulate. Studies have shown that it is effective in helping women with PCOS become pregnant. The test that your doctor has ordered for you is likely to evaluate your progesterone level. As I mentioned earlier, this hormone increases after ovulation, therefore, it would be present at higher levels in your blood about one week after ovulation which is about one week before the expected period.

Husband's sperm count

If you are ovulating and your husband's sperm count is normal, I recommend that you continue with regular intercourse (every other day) during the week of your expected ovulation. If you are not ovulating, you may need a higher dose of clomiphene. Alternatively, clomiphene and metformin used together may be more effective in helping you to become pregnant than either of them being used alone.

Finally, you have not mentioned whether or not you are overweight. If you are, your weight may affect your ability to ovulate on fertility drugs. Weight loss can not only help overweight women to become pregnant, but can decrease their risk of many pregnancy complications.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@ gleanerjm.com.