Q.: I have a four-year-old and have been trying to conceive another child for a year now. I’ve been diagnosed with Polycystic Ovarian Syndrome and irregular periods. My gynecologist put me on Provera to jump-start my periods, which works sometimes.This month, I started Clomid 50mg. and took it from days five to nine. My ovulation test was positive; I followed the directions to conceive. On day 21, I had a pregnancy test, which was negative, and a progesterone test that showed a level of 1.7. If I don’t start menstruating in the next few days, my gynecologist will put me back on Provera, and when my period starts, I will take Clomid 100 mg days five to nine. If this doesn’t work, then I want to try the intrauterine insemination procedure I read about. But I don’t think my insurance will cover infertility.What is the cost of the intrauterine insemination procedure and what does it involve? --Gina V., Deerfield BeachA: Polycystic Ovarian Syndrome (PCOS) is a condition that can result in irregular and infrequent periods, infertility problems in women and excessive hair growth. This condition has also been linked with impairment in glucose metabolism and lipid abnormalities. If you haven’t done so already, you should have a fasting glucose and insulin levels taken as well as a fasting lipid profile. Many women with PCOS have an impairment in glucose metabolism which, when corrected, results in improved fertility.Your gynecologist is doing many things correctly. Provera is frequently used in women with PCOS to ensure a regular cycle. Clomid is also common medication used to enhance fertility in women.With PCOS, it is common to need higher doses of the medication. Many women will require doses as high as 200 to 250 mg taken on days 5 to 9 of the cycle. The dose of Clomid is increased by 50 mg each cycle if ovulation has not occurred. Your progesterone level should be greater than 4 on day 21. Levels of less than 4 indicate that ovulation has not occurred and your Clomid dose needs to be increased.The intrauterine insemination (IUI) is a procedure where sperm is collected from your spouse and spun down into a concentrate, which is then delivered directly into your uterus. This bypasses the cervix and certain cervical factors that some women produce which impairs their fertility. The cost of an IUI procedure ranges between $2,000 to $4,000 per cycle. Before you go to this expense, you need to make sure your tubes are open and your spouse has a semen analysis to discover whether he has an adequate number of normal sperm. Dr. Katia Laremont, M.D. is medical director of Planned Parenthood of South Palm Beach & Broward Counties, Inc. overseeing four health centers in Broward County and one in Boca Raton. Planned Parenthood is dedicated to providing medically accurate information and affordable health care. For questions on this or other topics on women’s health, please contact Dr. Laremont at the Planned Parenthood Boca Raton Health Center: 561-368-l023 or klaremont@lovecarefully.org
