PCOS

AND GETTING PREGNANT

A BEGINNER’S GUIDE AND PATIENT STORIES OF HOPE
ALL ABOUT PCOS

What is PCOS?
Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in women of
childbearing age. It is estimated to affect up to 10 percent of reproductive-age women, but this may
in fact be a low estimate. The World Health Organization estimates that PCOS affects as many as 116
million women worldwide.

PCOS is a very complex disorder that is not cholesterol, and

well understood, but basically, women with heart disease over a
PCOS have hormones that get out of balance. patient’s lifetime.
Recognition of PCOS
This includes both the sex hormones as well
as hormones like insulin, which regulate blood While the genetics is important, as treatment
sugar and metabolism. Normally, the ovaries of PCOS are not can help control the
make very small amounts of male sex hormones well known, it symptoms and prevent
called androgens. In PCOS, the ovaries start does seem to run long-term problems.
making more androgens, which can cause in families, so the
patients to develop many small cysts in the chance of having
ovaries, stop ovulating, develop acne, and grow PCOS is higher
extra hair on the face and body. if other women
in your family have PCOS, irregular periods,
Patients with PCOS may also have a problem or diabetes. PCOS can be passed down from
called insulin resistance or impaired glucose either your mother’s or father’s side. In PCOS,
tolerance. When the body doesn’t respond symptoms often begin in the teen years. The
correctly to insulin, blood sugar levels go up symptoms and severity of the syndrome vary
and metabolism slows down. In addition to greatly among affected women. Recognition is
problems with gaining weight, this increases important, as treatment can help control the
the chance of developing diabetes, high symptoms and prevent long-term problems. 

FIGURE 1
Estimated by the World

28% OF WOMEN WORLDWIDE

Health Organization.

116 MILLION PCOS

MAY BE
THAT’S

AFFECTED
BY
 ALL ABOUT PCOS

Common Symptoms
Early diagnosis and treatment for all PCOS patients whether they are trying to conceive or not is
important. Many patients with PCOS are surprised to learn that not only will it affect their ability to
conceive, it also increased the risk of high cholesterol, blood pressure, heart attack, and stroke.

IRREGULAR CYCLES insulin due to resistance INCREASED ANDROGENS

of the ovaries can be an
One of the most common Some other symptoms
underlying mechanism for the
symptoms with PCOS include: excess facial hair or
hormonal imbalance resulting
is irregular menstrual body hair (hirsuitism), and
in the weight gain and other
cycles. Most commonly the acne. These androgenic signs
PCOS symptoms.
cycles become fewer and are due to elevated levels
more spaced out in time of androgens, masculinizing
(oligomenorrhea). Very severe INCREASED INSULIN hormones. Compared to
cases result in amenorrhea—a women of other ethnic
condition where cycles can LEVELS backgrounds, Asian women
stop altogether. Irregular Many women with PCOS also with PCOS tend to have
menstrual cycles, caused have a higher tendency to lower symptoms of excess
by hormonal imbalances, have diabetes; studies are hair growth due to the fact
result in either sporadic or a looking at the relationship that they tend to have lower
complete lack of ovulation, between PCOS and the body’s number of hair follicles in
the body’s process of releasing ability to produce insulin. the skin. In some patients the
of an oocyte or egg, causing There is evidence to suggest excess of androgens can cause
infertility. Infertility in women that high levels of insulin frequent abnormal uterine
with PCOS is usually due to contribute to increased bleeding issues, also known as
the lack of ovulation caused production of androgens, hypermenorrhea.
by hormonal imbalances. The which worsens the symptoms
abnormal release of hormones of PCOS. The high levels of We still don’t know what
from the brain lead to a lack insulin can also be manifested exactly causes PCOS. Like
of stimulation of the ovaries as dark patches of skin on the most medical conditions, there
to produce an egg, which back of the neck or armpits, is probably some genetic
in turn leads to the lack of called acanthosis nigricans. component. One does find
ovulation and ultimately High levels of insulin are also PCOS clustering in some
results in irregular menstrual believed to be the underlying families and races. At this time
cycles. mechanism of increasing a we don’t know exactly what
woman’s chances of heart- gene or combination of genes
related complications. The leads to the development of
WEIGHT GAIN levels of insulin linked to PCOS, but ongoing research
Some women with PCOS PCOS increase the risk for high hopes to answer these
also experience weight gain cholesterol, blood pressure, questions.
and difficulty with weight and atherosclerosis. These
loss. Women with PCOS tend conditions can ultimately
to gain weight more in the increase the risk for a heart
abdominal area, called central attack and stroke.
obesity. Elevated levels of
ALL ABOUT PCOS

How PCOS is Diagnosed

Although there are many easily identified markers of PCOS—like irregular cycles, excess body hair, and
weight gain—at this time there is no single test used to diagnosis PCOS. Physicians currently use one
of two sets of criteria when diagnosing PCOS. The first was sponsored by the National Institutes of
Health (NIH) and the second, known as the Rotterdam criteria, was determined by the European Society
of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine
(ASRM).

NATIONAL INSTITUTES THE ROTTERDAM The Rotterdam definition is

OF HEALTH CRITERIA CRITERIA broader and includes more
patients to be classified as
In 1990, the first general In 2003, ESHRE and ASRM having PCOS. It is important
consenus of criteria used established the Rotterdam to note that not all women
to diagnosis PCOS was criteria, named after the with PCOS have polycystic
agreed upon by reproductive city in which the consensus appearing ovaries on
endocrinologists and outlined workshop was held. Widely ultrasound and not all women
by the National Institutes used in Europe this with ovarian cysts have PCOS.
of Health (NIH) defined as a definition includes: Since the diagnosis does vary
woman having: and is not straightforward
. Decreased number . Irregular or absent menses it is a good idea to seek the
of menstrual cycles . Excess androgen activity help of a fertility specialist
(oligoovulation) . Polycystic appearing or an OB/GYN when PCOS is
. Signs of androgen excess ovaries on ultrasound
suspected.
such as a clinical excess as
in increased hair growth or
a biochemical excess, such
as increased testosterone It is important to note that not all women with PCOS
levels have polycystic appearing ovaries on ultrasound
. The exclusion of other and not all women with ovarian cysts have PCOS.
disorders, such as adrenal
and thyroid disease, that can
mimic PCOS symptoms

FIGURE 3
This illustration demonstrates a polycystic ovary
compared with a normal ovary. The reason it’s difficult
for a woman with PCOS to conceive is that all of these POLYCYSTIC NORMAL
OVARY WITH OVARY
follicles stay small. Her ovaries never produce a big
SMALL CYSTS
follicle that can be released.
 ALL ABOUT PCOS

Impact on Fertility
Ovulation is the result of a series of well-timed events and hormones. Initially, both ovaries have
multiple small follicles, most of which contain an egg. From this pool of follicles, usually one will
continue to grow and become dominant. The dominant follicle then is ovulated, or released, and it travels
into the Fallopian tube where it is fertilized by the partner’s sperm. Once fertilization has occurred the
egg becomes an embryo and travels into the uterus where implantation occurs.

In women with polycystic Obesity can further complicate

ovary syndrome, the ovary does these hormonal imbalances When is the Right Time to
not produce all the hormones and make the problems worse. See a Reproductive Specialist?
in the necessary sequence for
Woman’s Age See a Specialist After
an egg to fully mature. The
follicles may start to grow and TIMING IS KEY
<35 12 months
then stop or simply not grow Traditionally it has been of trying
at all. Some of the follicles suggested that women
may remain as cysts, frequently under the age of 35 try to
>35 6 months
seen in vaginal ultrasounds. If conceive on their own for of trying
ovulation does not occur then 12 months before seeking a
the ovary does not produce the basic infertility work-up and
critical hormone progesterone, Irregular Immediately
treatment. The time table in when ovulation
which is important in maturing the case of women, no matter Periods is irregular
the uterine lining. This then their age, with irregular or
results in irregular menstrual a complete lack of periods
cycles or in some cases no is shorter. Infertility is a very
cycles at all. time-sensitive disease. If rate of miscarriage in women
menstruation is not occurring with PCOS. Also, medical
or is irregular, do not wait to conditions such as gestational
In women with PCOS, seek a diagnosis from your diabetes and pregnancy-
the ovary does not produce OB/GYN or reproductive induced high blood pressure
all the hormones in the endocrinologist. are more prevalent in pregnant
necessary sequence of women with PCOS. Close
events for an egg to fully supervision and monitoring in
PREGNANCY AND PCOS pregnancy can help to reduce
mature.
Pregnancy without intervention these risks and sometimes
is possible; however, if you medication is used, such as
have irregular cycles, it is metformin to lower sugar
In addition, the multiple small difficult to determine if and levels.
follicles on the ovaries can when you are ovulating. Not
produce excess male hormones only is getting pregnant more
such as testosterone, which difficult but also keeping the
further negatively affect the pregnancy is more complicated
hormonal imbalance and lack in women with PCOS. Some
of ovulation. studies have shown a higher
ALL ABOUT PCOS

Treatment
There is no cure for PCOS. It is managed based on your symptoms and goals. Lifestyle modifications are
a good place to start. Since frequently women with PCOS are overweight or obese, healthy eating and
exercising is an important first step. Simply losing 5 to 10 percent of your body weight can help to jump
start a menses back to a regular rhythm.

ORAL MEDICATION
Since women with PCOS often do not ovulate regularly, oral
medication, such as clomiphene citrate (Clomid, Serophene), is
used to help induce ovulation. Clomid with timed intercourse or
intrauterine insemination (IUI) is usually the first step when a
patient is just beginning treatment either at the OB/GYN or with a
reproductive endocrinologist.
Oral medication is used
The natural chance of conception for women without infertility is to help induce ovulation.
approximately 20 percent a month. The goal with IUI treatment is
for patients to return to those natural chances. While under the care
of a reproductive endocrinologist, this is achieved by using Clomid to recruit and develop one or
two eggs. At the time of ovulation, the partner’s sperm is introduced directly into the uterus with an
IUI. This treatment places the sperm closer to the egg and at a higher concentration than would be
possible with conventional intercourse.

Sometimes the use of a medication like metformin is used in combination with Clomid to help treat
a sub-group of women with PCOS who have insulin resistance. Metformin helps to lower insulin
levels and as a result may help to induce ovulation.

INJECTABLE MEDICATIONS
If patients are not successful or responsive to Clomid, the next
low-tech treatment option is the use of gonadotropins, which are
administered as injectable medications. Injectable medications
induce the recruitment, maturation, and ovulation of eggs. A lack
of ovulation is fundamentally the problem in PCOS patients. With Injectable medications induce
treatment the goal becomes to induce the development and ovulation the recruitment, maturation,
of a single egg.
and ovulation of eggs.
Sometimes multiple eggs are recruited in a single cycle, increasing
the number of "targets" for sperm to fertilize and, as a side effect,
increasing the risk for multiples. At the point of ovulation the IUI is performed. Many PCOS patients
will be successful with low-tech treatments; those who aren’t however, can move to in vitro
fertilization (IVF) and more than double their chances of success. In general, studies have shown
that most pregnancies (75 to 80 percent) occur within three IUI treatment cycles. After the third
cycle patients will often move to a more advanced form of treatment.
 ALL ABOUT PCOS

IN VITRO FERTILIZATION
Many patients will experience multiple factors affecting their fertility,
such as low sperm counts, decreased sperm motility, or tubal factors like
blocked Fallopian tubes. For many of these patients, in vitro fertilization
(IVF) will be the first line of treatment.

Stimulation
In a normal cycle, usually one follicle will be recruited, develop, and
ovulate from the pool of immature antral follicles in the ovary. In a
woman with PCOS, frequently none of the follicles will mature. In an IVF
cycle, the goal is to have as many mature eggs as possible, as this will The goal is to have as
increase the odds of success with treatment. In the stimulation phase
of the IVF cycle, injectable medications are used for approximately 8 many mature eggs as
to 14 days to stimulate the ovaries and produce on average 10 to 20 possible, as this will
eggs. The stimulation phase ends with a trigger shot, providing final increase the odds of
maturation to the developing follicles and setting ovulation in motion.
success with treatment.
Egg Retrieval
The egg retrieval is the next step in the IVF process. During the procedure,
an ultrasound is used to guide a needle into each ovary and remove the follicular fluid and egg.
Patients will receive sedation during the procedure, which usually lasts 20 to 30 minutes.

Embryo Development
Once the eggs are collected they are taken to the embryology laboratory to
be counted and evaluated. PCOS patients frequently have a high number
of eggs retrieved as they respond well to the stimulation medications.
Once evaluated each egg is introduced to the sperm for fertilization either
through conventional insemination or intracytoplasmic sperm injection
(ICSI), most commonly used when the male partner has male factor
infertility. Each embryo is watched for development and typically transferred
on day 5.

Embryo Transfer
The embryo transfer is a simple procedure that takes about 5 to 10 minutes to complete. The
morning of the transfer, the embryologist will make a final embryo assessment. The doctor will
use the information provided by the embryologist and other factors related to your case, such as
your age and history with previous treatments, to make their recommendation on the number of
embryos to transfer. Since PCOS patients usually have several embryos, is it often suggested, based
on the patient’s age, to transfer a single embryo and freeze the additional for a subsequent cycle.
Transferring a single embryo brings the chance of multiples down to a conservative 2 percent.

Patients who use IVF have a high chance of pregnancy in any Patients who use IVF
given cycle. Some other benefits of IVF is that it gives the medical
team more control of the cycle, IVF gives more information as to have a high chance of
the quality of the embryos, and can reduce the risk of multiples by pregnancy.
encouraging single embryo transfers where possible.
ALL ABOUT PCOS

Success Rates
Both low-tech and high-tech fertility treatment for patients with PCOS have proven to be successful,
partly because patients with PCOS are able to create many follicles in a cycle. What was once considered
a curse—many immature follicles—can become a blessing with the right medication and treatment.

Patients who have higher numbers of antral Pregnancy Rate Per Cycle for IUI Treatment
follicles, like those with PCOS, can have a in Patients with Ovulatory Disfunction
significantly higher success rate with IVF when 25
compared with patients with other diagnoses.
20
Beyond knowing "Will I get pregnant?" it is

Pregnancy per Cycle (%)

also very important to know "Am I at risk for
multiples?" When considering treatment options 15

and potential outcomes it should be noted that

PCOS patients are at a higher risk for high-order 10

multiples when using low-tech treatment. The

chance of twins with low-tech treatment ranges 5

11 to 20 percent depending on the type of

medication administered. Patients using IVF and 0

choosing to transfer a single embryo will have 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

around a 2 percent chance of twins, the natural Patient Age (years)

Shady Grove Fertility IUI Treatment Data 2003-2006
rate of spontaneous twinning.

Pregnancy and Live Birth Rates for Patients

with Ovulatory Dysfunction Using Fresh IVF
60%
Patients who have higher
50% numbers of antral follicles,
like those with PCOS, can have
40%
a significantly higher success
30% rate with IVF when compared
20% with patients with other diagnoses.

10%

0
35 35-37 38-40
Patient Age (years)
Pregnancy Rate Live Birth Rate

Shady Grove Fertility SART IVF Treatment Data 2011

 PCOS
PATIENT
STORIES
OF HOPE
Colleen’s Story
Diagnosis: PCOS Treatment: IUI, IVF
Steve and I met in October 2004 and have been together ever since.
After 3 years of being together, Steve proposed. We ended up having a
long engagement because we both had goals of finishing college and
starting our careers. In June of 2012, we got married.
Right after we got married, I went barely able to breathe.
to my OB/GYN to talk to her about
planning for a child within the
next year. I knew my pregnancy SEEKING ANSWERS
would have to be planned since I
After all of the horrible
work with special needs students.
OB/GYN appointments and the three
I do not have a typical job and
months of being depressed cycles of
my students thrive on routine so
about the situation, I finally took timed
I knew I had to have a plan. Little
the initiative to look for more intercourse, followed
did I know that it would not be
information regarding infertility. by IUI, and then if we do not have
easy to get pregnant. Everyone
I was not going to allow for my any success we would do IVF.
around me made it look so easy.
OB/GYN to stop me. I knew I had
They were able to get pregnant
more options and not just IVF.
without even trying. The plan was
I had heard wonderful things BEGINNING TREATMENT
to get off of my birth control and
about Shady Grove Fertility, so
start taking prenatal vitamins We ended up doing only one cycle
I looked for more information. I
until the time was right. I asked of timed intercourse. My insurance
went on their website and made
my doctor if my weight was a was changing so I wanted to use
an appointment to go to an
concern and she told me that I my benefits before we lost them.
informational open house.
was at a higher risk for things like We decided that IUI was the best
preeclampsia but no indication route for our second cycle.
At the open house, I met with
that I would have trouble getting
the wonderful staff of Shady
pregnant. After an ultrasound, it showed
Grove Fertility. I learned so
that I had two huge follicles this
much information and met Dr.
After trying for 8 months, I went cycle and ended up scheduling for
Bromer. After listening to him
to go see my doctor to talk about our IUI. I was so nervous because
speak, I knew he was the doctor
infertility. My husband came I did not know what to expect.
to help us. Every word he had
with me but was told he wasn’t We dropped off my husband’s
to say, spoke to me. We left that
allowed in the room. The first specimen and had to wait another
day making an appointment to
thing my doctor said was, “I was hour for the procedure. I felt sick
sit down with Dr. Bromer in the
not ovulating because I was to my stomach just having to wait.
Frederick office to see what our
overweight.” She told me that she It felt like forever until it was my
options were.
would not run any tests until I turn. I had to lay on the table with
lost 25 lbs. She told me that if I a huge bright light shining into
I was so anxious to sit down with
lost the 25lbs she would consider my lady parts. Dr. Bromer inserted
Dr. Bromer and finally get some
IVF. How could she tell me this the tubing and it was done within
answers. I knew he was going to
without doing any tests? She also minutes. He then threw my legs
go over our medical information
decided to try and comfort me up in the air and told me I had to
and hopefully he would be able to
by saying “It must be hard seeing wait like that for 10 minutes. The
come up with a plan for us. After
all of your friends pregnant and
reading through all of my medical
you are not.” Did she honestly
history, Dr. Bromer informed
think that was going to help the
me that I have polycystic ovary
situation???? I was devastated
syndrome (PCOS). Dr. Bromer
and left my appointment in tears
decided that we were going to do
hardest part of the procedure was COLLEEN’S ADVICE
the dreaded 2 week wait to see if
it worked. My advice to other patients is
to never feel like you are alone.
There are so many people
THE TWO WEEK WAIT around us who also struggle
with infertility. My way of helping
We were not able to go into the cope with everything I was going
office for a blood test because through was to blog about it. It
we were on vacation. After just was a great avenue for getting
celebrating our 3rd wedding everything out and helped my
anniversary, I took a pregnancy family understand without having
test and it was POSITIVE!! It took to ask all of the time. I would
about 30 seconds for the test to highly recommend consultation
show that I was pregnant! with Shady Grove Fertility as
early as possible in your journey.
Once we got back from vacation I You need to be an advocate for
had to get my blood test done for yourself and fight for what you
confirmation. We scheduled our want.
ultrasound when we found out
that I was pregnant with twins
and that my due date is February
22, 2016. Our babies came a few
weeks early on February 6, 2016.
I can’t thank the Frederick office
of Shady Grove Fertility enough.
Every time we interacted with Dr.
Bromer and his staff, we were met
with warmth, professionalism, and
true kindness. They made us feel
so comfortable and had our best
interest at heart.
Jessica’s Story
Diagnosis: PCOS Treatment: IVF, FET
Like most women, all my life I knew I wanted to have children. I never
thought that I would ever have “trouble” conceiving on my own. I
started having irregular menstrual cycles when I was in high school
so my OB/GYN put me on birth control pills to regulate my periods.
Still being so young I didn’t think anything of it. I just thought this is
normal, no big deal.

Well, all through college I stayed office to see Dr. McKeeby. I went
on birth control pills and when I through a series of tests to
met this guy towards the end of determine what was going on Dr.
my college years who would later so Dr. McKeeby could best treat McKeeby
become my husband, I thought my case. It was determined that looked at our
that once we got married I would I had some signs of PCOS and insurance and said
get off of birth control pills and endometriosis and I had a cyst on that since it covers IVF we should
get pregnant, easy. I soon found both ovaries, but nothing to be go that route. So my husband
out that it wasn’t as easy as I alarmed about. My husband did and I agreed and the injections
thought. Because I was on birth all of his testing and everything began. The injections were not
control for over 6 years, I thought came back normal, so it was all too bad but they did leave the
that by stopping the pills right me. What a weight that was on area a little sore after the first
before my wedding day it would my shoulders. I became upset and couple of days. My trick to help
allow me to get pregnant on my frustrated with myself because I ease the pain of getting a needle
honeymoon and my new husband wanted to know why I couldn’t get every day was to ice the area
and I would soon be announcing pregnant like everybody else. before doing the injection and I
that we are expecting. A few place the oils under my arm to
months after my husband Eugene warm a little before extracting
and I got married there was a BEGINNING TREATMENT them with the needle from the
pregnancy announcement in my bottles. Fortunately, my husband
From October 2012 (when we
family but it wasn’t from us, it was was the one who administered
started at Shady Grove Fertility)
from my sister. I was excited to be my injections and he was more
to about March or April 2013
an aunt so I didn’t think much of nervous than I was. He hated
we tried Clomid (again) with
it, just thought it hadn’t happened giving me injections because I
timed intercourse and went in
for us yet. would tense up when the needle
for monitoring. What a job that
would go in and having to watch
became and it was unsuccessful.
the needle puncture my skin and
SEARCHING FOR Then in May 2013 the cyst
sometimes bleed wasn’t a pretty
on one of my ovaries became
ANSWERS really enlarged and I was told
site for him to look at every day. It
became like a chore that we did
to stop treatments and have it
Fast forward 3 1/2 years into our every night. A couple of times I
removed by my OB/GYN. This
marriage and still no baby. My didn’t want to have the injection
was heartbreaking because I just
OB/GYN recommended I start because I was sore and too lazy
wanted to have a baby and didn’t
taking Clomid so we did that to get up to ice myself, gather all
want to prolong the process any
twice. Still no luck and no baby. the materials etc. but we did what
longer. So after I had my surgery
She then recommended that I go we had to do in order to bring our
to remove the cyst, my husband
to Shady Grove Fertility. baby into the world.
and I went through some personal
issues and we did not start
So I called and made that first
treatments again until December
appointment with the Annapolis
2013.
I knew this time was going to be March 2014 was our FET. That
it, we were going to conceive. I went great and again the dreaded
had a few friends get pregnant 2 week wait. I actually got sick
around this time naturally and the night before the pregnancy
I believed I was going to join test so my husband and I prayed
them soon. The medicines worked to God really hard that I got
great, my egg retrieval was great sick because I was pregnant.
(33 eggs retrieved), my husband’s I went in the next day for the
sperm count was great, and I had pregnancy test and received the
13 embryos that were in excellent call later that day with the best
condition. news I’ve ever received.....I was
pregnant! I jumped for joy, cried Hello again injections! We
So January 2014 was the day of happy tears. My husband and our were scheduled for our FET in
our fresh embryo transfer. We entire families were so happy October 2015 and received the
were so excited that it went and excited for us. On November call that we were not pregnant.
well. We had to go through 29, 2014, we gave birth to our My husband and I decided to try
that long 2 week wait for the princess Carmen as a result of again immediately, which meant
pregnancy results. The day arrives the successful FET. She was a more injections and meds.
and I received the call that I perfectly healthy little girl and
was not pregnant. Talk about she is such a joy. On December 2015 we completed
heartbreaking. My husband and another FET and received the call
I agreed that we wanted to try that we are PREGNANT (currently
again right away. So we did the ROUND TWO 8 weeks)! We graduated from
injections all over again. This time My husband and I decided to “try” Shady Grove Fertility on January
I also really watched what I was again and have a second child 21, 2016, and moved back to my
eating, and worked out once in a and since we decided to freeze regular OB/GYN. My husband and
while. the remaining embryos we went I are so grateful to God and the
back to Shady Grove Fertility in doctors, nurses, and staff of Shady
August 2015 to do another FET. Grove Fertility for giving us the
blessings we always wanted.

JESSICA’S ADVICE
To all future patients my advice
to you is to never give up on your
desires, trust in the promise, keep
the faith, and remember you are
not alone.
Devin’s Story
Diagnosis: PCOS Treatment: IUI
I got my first period when I was 16. I was always “too thin” according
to my doctor, so I was not surprised by the late coming period. My
periods were very sporadic. I was put on birth control to induce
periods. After graduating from college, I gained about 40 lbs. I went
to my nurse practitioner and she suggested getting bloodwork done
and later confirmed PCOS was the culprit. I did not know anything
about PCOS. I searched the internet for symptoms, but found the worst
stories about how women with PCOS can never have children. I was
mortified! My husband knew how devastated I was, but was super
comforting and assured me everything would be ok.

Christopher and I met in 2010. he could do to help us get

I graduated from college in pregnant. He made us feel so
Virginia and went back to live in comfortable and hopeful. After it we were to move on to IVF. I
my hometown, where I regrouped was confirmed that I was in fact never thought we would conceive
with some friends from high battling PCOS, we immediately on the first IUI.
school one night. Christopher started treatment using Clomid.
was at the gathering, and turned This went on for about 3 months We successfully became pregnant
out to be related to my friends because we started with the (the 2 week wait was agonizing)
from high school. I instantly felt lowest dose and kept working with twins! The 2 week wait was
comfortable with his family... our way up. When the highest so difficult because my body was
probably because I already dose of Clomid wasn’t working, going through changes and every
knew some of them. We had a we were told we needed to start time I felt a strange physical or
quick connection and moved in with Gonal-f shots. I was terrified emotional symptom, I hopped
together in 2011. He proposed at the thought of sticking myself on the internet and searched
in November 2011 and we were with a needle every day, but we EVERYTHING. That was the
married in October 2012. Once were willing to do whatever it worst decision. I spent my days
my husband and I were married takes in order to start the family google searching and developed
we wanted to have children right we’ve always dreamed of having. terrible anxiety. I remember the
away. The dilemma we were faced Upon starting the shots, I began day my nurse called. I waited to
with was when I stopped taking eating clean and losing weight. I listen to the voicemail because
birth control I did not get a period lived my life around making sure I was nervous about receiving a
and therefore, was not ovulating. I was healthy during treatments. negative result.
The PCOS likely had something to I became so preoccupied and
do with this. We tried metformin scared that I pushed my friends On our last ultrasound with Shady
to regulate my periods and that and family away. Every time we Grove Fertility, we found out
did not work. We gave up trying went for an ultrasound, the shots one of the babies did not have a
on our own in 2013 and went to were not working so we had to heartbeat. We were devastated,
Shady Grove Fertility. increase the dose. This went on but reminded ourselves that
for about 1 month and then we everything happens for a reason.
finally had two viable eggs! We were still over the moon
DECIDING TO SEEK ecstatic to be pregnant with one
TREATMENT We ended up doing one round of
IUI to start. However, Dr. Osheroff
Our first meeting with Dr. Osheroff told us that it could take up to
was very promising. He told me three times for it to work. If it
that he would do everything didn’t work the first three times,
baby. The nurses and doctors were having regular periods since my
with me every step of the way. I pregnancy, for the first time in
cried and laughed with them on my life. We are going to try for a
many occasions, and they always second child on our own, but if we
made me feel so comfortable. are unsuccessful we will definitely
They never gave me false hope be returning to our friends at SGF.
and provided the most honest
answers and information. They
always let me know what the DEVIN’S ADVICE
worst outcome would be, so I
Keep trying and don’t alienate
was pleasantly surprised with the
friends and family as I did. I
pregnancy. I did not expect it to
pushed everyone out and kept our
happen so quickly.
struggle a secret. I now realize
that letting everyone know what
BECOMING PARENTS was going on would have been
the better choice. At the time,
I gave birth to my daughter I was embarrassed and felt so
Charlotte on 12/27/14 via alone. Now I know so many other
emergency c-section due to HELLP people have been through this
Syndrome. It was a scary day, but process, and talking openly about
Charlotte and I both came out it would have made my treatment
of the surgery perfectly healthy. process so much easier.
Our family of three is perfect and
I owe it all to Dr. Osheroff and
his team. The life we have now
would not be possible without
them! I have actually started
PCOS PATIENT STORIES

Tamara’s Story
Diagnosis: PCOS Treatment: IUI
I was always the chubby girl growing up. I have struggled with my
weight for as long as I can remember. I could eat all things healthy
and it wouldn’t matter, the number on the scale would stay the same.

I met my husband, my prince, Dr. Esposito sat down with me

when I was 19 and we were and my husband, and told us
married when I was 20. He the hard truth that if I wanted
thought I was beautiful inside and to be a mother, I had to lose
out, and my weight was pushed weight. Knowing that my weight
to the back of my mind. We knew was one of the things stopping
from the very beginning that we me from being a mother was fertility
wanted to be parents. My periods heartbreaking. How could I have treatment.
were always so irregular, heavy, been so selfish? My weight was We were so
and painful. We were not using not only stopping me from being excited,
any protection for 3 years and we a mom, but stopping my husband anxious, and
knew that it should have already from being a dad. nervous!
happened. I began to worry
that it was me. I scheduled an Going through the testing,
appointment with my OB/GYN to Dr. Esposito found that my thyroid SUCCESS WITH LOW-
talk about getting pregnant. He was hypo-active. My total blood TECH TREATMENT
did an ultrasound and said that count was low and my lining of
I had metabolic syndrome and my uterus was super thick. First On our first IUI cycle, we got
PCOS. thing I had to do was get a blood pregnant but unfortunately
transfusion. I immediately started it turned out to be an ectopic
to feel better after this! My energy pregnancy. Dr. Esposito and our
COMPLETING THE level sky rocketed! Next I had nurse Elizabeth were so
EVALUATION to get a D&C to find out why compassionate and
my lining was so thick. They did understanding. Dr. Esposito sat
I knew what PCOS was because a biopsy and everything came with us and listened to all of our
my sister also has it. My doctor back ok. All those years of not fears and questions. She treated
started me on metformin and having regular periods and going us like we were her only
Clomid. I was on this regimen for untreated for PCOS had caught up patients. We had to wait
a year and nothing happened. I with me. 3 months before trying
would go in monthly for check- again.
ups and I would never ovulate. Next, Dr. Esposito referred me to
My doctor said he had done an endocrinologist who diagnosed
everything he could and would me with Hashimoto’s thyroiditis,
“Knowing that my weight was
have to refer to me a fertility a swelling of the thyroid gland
specialist. That brought me to that can result in reduced thyroid one of the things stopping
Shady Grove Fertility. I knew I function. Once I got on medication
me from being a mother was
was in great hands because my to help regulate my thyroid for the
sister already had a Shady Grove first time I started to see weight heartbreaking.”
Fertility miracle of her own. loss! I got a gym membership and
a treadmill. Every day I would get
I met with Dr. Esposito, and I on my treadmill it didn’t seem
felt so comfortable with her. I like a chore anymore but part of
wondered why we had waited my daily life. I lost 50 pounds and
so long to get to this point. we got the green light to start
 PCOS PATIENT STORIES

Those 3 months were so hard, Esposito and God we wouldn’t

I was so afraid I would gain have our son, but also I wouldn’t
weight and would not be able have found out all the other
to try again. I worked at it every issues I had.
day and came back swinging
ready to try again, but our next Life now is beautiful! I still
two IUI cycles were unsuccessful. struggle with my weight but
However, our fourth IUI is the one I plan to keep working at it! My
that we got pregnant with our goal is to be healthy not skinny,
son. Had it not been for Dr. and to live a long, active life
watching my son grow up. This
experience has brought me and
my husband closer together. It
has restored our faith, and we
now know miracles are possible.
My main advice to others in
treatment is to not give up.
Even when you feel like you
are fighting a losing battle, stay
strong! 
PCOS PATIENT STORIES

Stephanie’s Story
Diagnosis: PCOS Treatment: IVF, FET

I was a secondary English teacher in the County, and my husband

worked in the fire department before getting a job with the state
police. After being together for 6 years, in December 2010, we got
married and decided right away that we wanted to start trying for a
baby.

I was diagnosed with PCOS My first IVF cycle started out well,
when I was a teenager. Pretty but ended up in disaster. I was
much right after I took myself projected to get 15+ eggs, but
off birth control, my cycles were when I woke up, they told me I protocol
very erratic, lasting anywhere only had three, and that I had than
from 3 to 6 months long. My ovulated early. We put back two what I was
OB tried to put me on Clomid day 2 embryos, but we did not doing before—an
to help regulate my ovulation, end up pregnant. antagonist protocol—and
and while it did help me to said he’d be really aggressive
ovulate, I still wasn’t getting The second IVF attempt was also with the stimulation drugs.
pregnant. It was at that point a disaster. We were projected Excited, but scared, I started
that he recommended me to a to get about 10 eggs, but again, another IVF cycle.
reproductive endocrinologist. I I woke up and only 3 were
was only 26. retrieved. Only one fertilized, This cycle, our third, was much
which we also put back on day more productive than my first
2. This cycle did not end in a two cycles. Using the antagonist
SEEKING TREATMENT pregnancy. protocol, we retrieved 18 eggs,
15 of which were mature, and 9
I didn’t originally start out
At this point, I was very of those fertilized and made it to
at Shady Grove Fertility.
defeated. My prior reproductive day 5. We transferred one embryo
I immediately started IUI
endocrinologist told me I’d on Thanksgiving Day, and four
treatment, since the Clomid was
probably have to use donor eggs, were frozen on day 6. Although
working for me, and I wasn’t
since my eggs were dying before my third fresh cycle didn’t end in
presenting any other issues.
they could retrieve them. He a pregnancy, I was confident that
After three failed IUI attempts, I
also told me to go home, lose 30 this wasn’t the end of my journey.
was told that moving on to IVF
pounds and call them after that
would be my best option. It was
so we could start again. I was We chose to do a FET instead
a heartbreaking blow, since I was
devastated, and I couldn’t figure of another fresh cycle. I was
so young. I didn’t understand
out why this was happening to frustrated that my body wasn’t
how I got to be in the situation of
me. I took 2 months off before getting pregnant. Dr. Yazigi
having to decide to continue with
deciding to get a second opinion. suggested that I do a couple of
IVF or stop trying. We didn’t want
endometrial biopsies before my
to give up though, so we decided
next cycle. He explained that
to move forward with IVF. HANGING ON TO HOPE sometimes, the biopsies help
the lining of the uterus, since I
“After three failed IUI When I went to Shady Grove
was experiencing "implantation
Fertility, Dr. Yazigi welcomed
attempts, I was told that me with open arms. He had a failure" due to unknown reasons
this would be the next best step.
moving on to IVF would lot of confidence in moving
forward, and didn’t agree that
be my best option.” my egg quality was an issue at
all. He suggested I try a different
 PCOS PATIENT STORIES

I was on board, and we moved STEPHANIE’S ADVICE

forward... again.
It hurts. It is going to hurt. You are
For our FET cycle, we chose to put back going to feel alone, and it isn’t fair that
two, day 6 blastocyst stage embryos. you have to go through this... but you
Four days after the transfer, I caved in cannot give up. A friend, who had also
and took a pregnancy test on a whim. gone through treatment, told me this,
It was positive! I could not believe and I say it to other women all the
that after 27 months of trying, we were time: It sucks that it doesn’t always
finally, finally pregnant! work. It hurts, and you will cry and ask
God why you are going through this.
I am 32 weeks pregnant now with a But remember, whatever it takes to get
healthy, little boy. We are very excited to your child... it happens for a reason.
for October 6th to get here so we can If you didn’t go through what you did,
meet our little man. It was a long, long you wouldn’t have the child that you
journey, but I am glad that I didn’t give end up with, and that child was meant
up. I kept a blog through the very start for you. Don’t look at your failures as
of my fertility treatments, and I am so being pointless... look at them as being
happy that I can look back on it and necessary for getting to the baby that
realize how strong I was to face all of was meant for you.  
that failure and not cave in.

Stephanie at 32 weeks.

FERTILITY FACT
1 in 8 couples will
experience infertility
PCOS PATIENT STORIES

Kathleen’s Story
Diagnosis: PCOS Treatment: IVF, FET

We had been trying to get pregnant for 1 year prior to seeking a

fertility specialist. I was doing everything right, tracking ovulation,
taking ovulation predictor tests, doing basal body temperature and
timed intercourse. I soon realized that I didn’t ovulate normally,
having cycles anywhere from 35 to 60 days long.

After months of long cycles—some I took a few months off and

of which were anovulatory, which really needed to get to a better
is a menstrual cycle in which place emotionally before I could
the ovaries did not release an get to a better place physically. I
egg—we sought help from Shady sought the help of a wonderful
Grove Fertility. After several tests, nutritionist and joined a gym. I
we discovered I had a completely started the "Couch to 5k" program,
blocked left tube, PCOS, and a and with hard work and the most
male factor. We were told we had motivation a girl could ask for
a less than 1 percent chance of (a baby), I lost almost 25 lbs!
conceiving naturally. I contacted my nurse to do an
official weigh in. We both jumped
for joy when I weighed in and was
MOVING STRAIGHT TO told we could move forward with
IVF the FET cycle.

We decided not to try IUI and April 2nd, 2012 we transferred a

go right to IVF. Being 26 when beautiful thawed embryo. And 2
we started the process, I was weeks later, nearly 2 years to the
convinced the first cycle would day of when we first started trying,
work. We did everything right I found out I was pregnant!
and had five beautiful embryos
make it to day 5. We transferred On 12/12/12 we welcomed the
back one "textbook" embryo; I was biggest joy of our lives, our son,
heartbroken when we learned Evan. After a long and emotional “We were told we had a
it didn’t work. I was emotionally journey, I would do it all again 10
devastated and grieved the loss times over! It was worth every less than 1% chance of
of this perfect baby I was so injection, every tear shed and mile conceiving naturally.”
sure I was pregnant with. The ran. He is the light of our life and
consultation with Dr. O’Brien after I feel so blessed (and hopeful) to
the failed cycle was disheartening. know we still have three embryos
I was told they would like me waiting for us to possibly join our
to lose some weight before we family as future babies.
would try again.
 PCOS PATIENT STORIES

KATHLEEN’S ADVICE be a hard road, but talking to a

fertility specialist and finding
There is nothing more frustrating out what is going on is the first
and emotional than struggling to step. Knowing what your body
conceive. Being told you cannot is or isn’t doing is somehow
conceive naturally is devastating. reassuring, and then making a
There is a grieving process that plan to get your baby is even
people don’t tell you you’re more exciting.
entitled to. You grieve the loss
of the life you realized you no We can’t thank Shady Grove
longer live: the one where you Fertility enough for helping us
unintentionally get pregnant bring amazing this blessing to us! 
or think you might be. No one
prepares you for infertility.

But the beautiful thing is that

we live in an age of medical
advances and technology.
Pregnancy is still possible. It
may be a long road, and it may
 Reading
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Shady Grove Fertility is the largest and one of the most successful fertility centers
in the United States. With over 30 physicians across Maryland, Pennsylvania,
Virginia, and Washington, D.C., Shady Grove Fertility performs thousands of
fertility treatments each year. The physicians and staff work hard
to provide each patient with an individualized treatment plan and
personalized care and guidance through their journey.

To learn more about treatment and affordable care options,

please call 888-714-4724 or visit [Link].

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SEPTEMBER 2016