Tuesday, March 13, 2012

Do I have PCOD ? or poor ovarian reserve ?

Many infertile women have irregular cycles. While most patients and doctors understand that irregular cycles cause infertility , they are often confused as to how to make the correct diagnosis – and how to treat this common problem.

Remember that the reason your periods are irregular is because you do not ovulate. This is called anovulation. Now the commonest reason for this in young women is PCOD. Since common things occur commonly ( and as a medical aphorism states, when you hear hooves you should think of horses rather than zebras), many doctors automatically make a diagnosis of PCOD for every young infertile women they see. Sadly, the eye only sees what the mind knows , and it seems to be a reflex knee-jerk response to diagnose practically every woman with irregular periods as have PCOD in certain parts of the world, such as the Middle East. Nearly all of them are labeled as having PCOD and treated with metformin, just because they are overweight and may have abnormal insulin resistance.

Unfortunately, this is often misdiagnosed and overdiagnosed. Not all women with irregular periods have PCOD , which is why it's important that you be well informed to ensure that your doctor is making the right diagnosis for you.

There are two sets of tests which can help provide clarity as to what is going on. The first are blood tests to check your ovarian reserve , and these included the AMH level; and the FSH and LH level. Patients with PCOD have high AMH levels; and high LH:FSH ratios. Patients with poor ovarian reserve have exactly the opposite – low AMH levels and high FSH:LH ratios !

An even more reliable test is the vaginal ultrasound scan to check your antral follicle count. This is an extremely easy test to do , but it's important to find an expert to does this reliably . He should provide you with images of your scan in a digital format , so you can review them and send them to a doctor for a second opinion. It's quite easy to count the number of antral follicles when the vaginal ultrasound scan is done reliably.

Unfortunately, many doctors are not good at differentiating polycystic ovaries from multicystic ovaries. Just because the patient is obese, they mindlessly label the patient as having PCOD ( even though the ovarian volume is not enlarged; and the stroma is not increased). This misdiagnosis wastes a lot of time and money.

Patients with poor ovarian reserve will have a reduced antral count ; whereas those with polycystic ovarian disease will have an increased antral follicle count with increased ovarian volume and increased ovarian stroma. Thus it's quite easy to differentiate between these two possibilities with the help of a well performed vaginal ultrasound scan.

What happens if you have irregular periods and don't fall into either of these two categories ? This is possible – and the key in that case is not to waste time trying to make a diagnosis, but rather to focus on treatment. The good news is that it's possible to induce ovulation very effectively , provided your ovarian reserve is normal !

Confused ? I'll be happy to provide a free second opinion if you fill in the form at
http://www.drmalpani.com/malpaniform.htm !

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