The spotting in PCOS patients is usually related to the dysfunction of the ovaries. I think that it changed subsequent to the HSG was coincidental. Remember that when bright red bleeding starts it is regarded as the onset of the period. The fact that the pain only follows a day or 2 later can be due to the possible presence of endometriosis.

- Bi-Week 30 answers kindly provided by Dr. Stephan Volschenk -

PCOS is still an enigma to this day. We seem to think that the condition is polygenetic and dependent on environmental factors based on what we know thus far  – we just do not know which ones. Research is ongoing, but no definite cure or intervention, other than what is available today, is available at present.

- Week 29 answers kindly provided by Dr. Stephan Volschenk -

Because an AMH was not before the ovarian drilling one can not comment on whether the drilling caused the low AMH.

- Week 27 answers kindly provided by Dr. Stephan Volschenk -

Well balanced eating plans and lifestyles are of more value than socially fashionable supplement. These can be obtained from dieticians with a special interest in PCOS.

- Week 27 answers kindly provided by Dr. Stephan Volschenk -

Research into medical conditions is an ongoing thing and papers are published on a daily basis about new theories on possible ways to manage these conditions. The Vitamin D issue is an example of exactly this. This is just a theory and of no value until proven in rigorous trials. Some patients with PCOS seem to have a deficiency in Vitamin D. This is only a small percentage, and furthermore, it is unclear whether this is a cause or effect of the PCOS, or even related to the condition. Therefore for now it is totally irrelevant in the management of PCOS and therefore no dosages are known.

- Week 27 answers kindly provided by Dr. Stephan Volschenk -

Inositol is a new kid on the block as far as PCOS is concerned. However, recent work seem to demonstrate a beneficial effect in the management of PCOS.

30-40% of PCOS patients have impaired glucose tolerance, and the defect in the insulin signal pathway seems to be implicated in the pathogenisis of insulin resistance. For this reason insulin lowering medication presents novel therapies for restoring spontaneous ovulation. The administration of different forms of inositol is demonstrated improving the physiological  insulinreceptory, restoring ovulation and quite possibly improving egg quality.

- Week 19 answers kindly provided by Dr. Stephan Volschenk -

Unfortunately it is not that simple, even for a PCO. The difference between a PCO ovary and a non PCO ovary is the fact that the PCO ovary has many many more pre antral follicles than a non PCO ovary. When you stimulate the PCO ovary, you recruit most of that follicles, if not all, in some way or another – hence the risk of OHSS. At the end of the attempt the ovary has to go essentially through the same process as the non PCO ovary. Therefore it ends up being the same for both PCO and non PCO.

- Week 17 answers kindly provided by Dr. Stephan Volschenk -

Glucovance and Glucophage is exactly the same thing. It is the same drug, manufactured by 2 different companies, hence having 2 different trade names. Generically they are however both metformin. Actos on the other hand is not a different brand, it is a different drug altogether, and as far from metformin as the east is separated from the west. For the right indication metformin will always be the drug of choice as for as PCO goes. Due to its high side effect profile about 40% of patients can not tolerate it. The alternative would then be to use something like Actos or an equivalent as this has also been shown to be beneficial in randomised trials. The issue with the Actos is however that it needs to be discontinued as soon as pregnancy is confirmed.

- Week 16 answers kindly provided by Dr. Stephan Volschenk -

The following factors:

- The pre trigger estrogen level
- The amount of days coasted
- The rate of estrogen level decline during coasting
- The endometrium and its ability to function properly.

- Week 16 answers kindly provided by Dr. Stephan Volschenk -

There is no predictable trend and each ovary responds in its own unique way.  Triggering “early enough” is confusing as there are guidelines as to when the trigger should be administered. According to these guidelines, the trigger should be administered as soon as the leading three follicles have reached a mean diameter of 17 – 18 mm in order to have the best result.

- Week 16 answers kindly provided by Dr. Stephan Volschenk -