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Expert Q&A

	By Lawrence B. Werlin Fertility Specialist

I would think that you do not get too many questions from men, but I am the one who is more emotionally wrecked over this than my wife. She has been diagnosed with PCOS. After nine years of using no birth control and having more tests done than anyone can imagine, why are we still not parents?

We have been to a fertility doctor, and her tubes are all clear. She has been on Clomid several times. We have not done the in vitro, as the doctor says my wife is too fat and the risks with a woman being overweight and pregnant are not worth the risk to the mother or child. She weighs about 205 pounds and is only 5 feet tall. Is her weight that big of a factor, or is the doctor just insensitive?

Also, how does her PCOS affect her ability to get pregnant? We follow the calendar every month, and her cycles are 28 to 32 days. She sees an endocrinologist due to the PCOS and her hormone levels, and she has told us that my wife does ovulate. The big question is when. We have been told that women ovulate on the 14th day before her next period. We watch the calendar, and the week of the 14th day (days 12 to 16) we have sex several times.

As for my sperm count, I am told it is in the normal band, but I believe the count to be at the low end of the acceptable range. Is there any hope for us?

It sounds as though you have had a roller coaster experience that many couples share during an infertility evaluation. Let me try to answer your questions.

1. To determine ideal weight, typically for a woman, one uses 60 inches (5 feet) with a baseline weight of 100 pounds at that height. For every inch over 60, one adds 4 to 6 pounds to determine ideal weight. When a woman is 20 percent above or below her ideal weight, the cycling mechanism can be impaired. It appears as though your wife is outside the limit of her ideal weight, and thus this could be a significant factor.

2. Her PCOS plays a role in her ability to achieve a pregnancy due to various hormonal factors controlling her ovulatory process. Various medications can be useful in helping to control this, including glucophage, and various ovulation induction medications, both oral and injectable. Unfortunately weight can be a significant factor in PCOS, again with respect to controlling ovulation. As you can see, these two factors can be closely related.

3. Women do not necessarily ovulate on the same day each cycle. The only fixed part of the cycle is from the point of ovulation to the onset of menses. That number is 14 plus or minus two days. Thus, if a woman has a 28-day cycle, she may ovulate somewhere between day 12 and day 16.

4. A giant first step would be to encourage your wife to consider a weight reduction program in association with good nutrition and exercise. Once this process has begun, you both may find that it will be easier to achieve your desired goal. Also, if necessary, you may re-think your desire to undergo a new infertility evaluation.

I wish you the best of luck."

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