The Case of Emily: Navigating Severe PCOS and Infertility at 38
Emily, a 38-year-old business consultant, had spent years building a successful career before deciding it was time to start a family. But after two years of trying to conceive and experiencing only frustration, Emily knew something was wrong. Her irregular periods, unexplained weight gain, and occasional facial hair had always been dismissed as minor issues, but they now seemed connected to her inability to get pregnant.
What followed was a long and challenging journey through the complexities of Polycystic Ovary Syndrome (PCOS) and infertility. Emily’s case demonstrates how even severe PCOS can be overcome with persistence, adaptability, and advanced fertility treatments.
Step 1: A Late Diagnosis
Emily’s first step was consulting with a fertility specialist, Dr. Rebecca Cole, who listened carefully to her history. Emily described her menstrual cycles as unpredictable, sometimes going three months without a period. She had also noticed gradual weight gain over the last five years, despite exercising regularly.
Dr. Cole suspected PCOS and initiated a comprehensive diagnostic process.
- Bloodwork:
- Elevated androgens confirmed hyperandrogenism.
- Insulin resistance was evident from her high fasting insulin levels.
- Her LH-to-FSH ratio was elevated, consistent with PCOS.
- Ultrasound:
- Emily’s ovaries were filled with numerous small follicles—classic signs of polycystic ovaries.
- Ruling Out Other Conditions:
- Normal thyroid and prolactin levels excluded other potential causes of her symptoms.
Dr. Cole explained:
“PCOS is a hormonal disorder that affects ovulation and fertility. At 38, Emily also faced age-related declines in egg quality, adding an extra layer of complexity to her case.”
The diagnosis: Severe PCOS with chronic anovulation and insulin resistance.
Step 2: Initial Treatment—A Rocky Start
Dr. Cole recommended starting with lifestyle changes to improve Emily’s insulin sensitivity and overall hormonal balance. Emily was determined to follow the plan but quickly encountered difficulties.
1. Lifestyle Changes
Emily adopted a low-carb, high-fiber diet and began exercising five days a week. Despite her best efforts, she lost only 3% of her body weight over six months—a discouraging result given her commitment.
Dr. Cole reassured her:
“For women with PCOS, weight loss can be much harder due to insulin resistance. Even modest improvements can help, but we need to add medications to support your progress.”
2. Adding Medications
Emily began taking metformin to address her insulin resistance. While it helped stabilize her blood sugar levels, she experienced gastrointestinal side effects, including nausea and diarrhea. After several dose adjustments, Emily was able to tolerate the medication.
3. Ovulation Induction
After three months on metformin, Dr. Cole started Emily on Letrozole to stimulate ovulation. The first cycle showed no response, and the dosage had to be increased. By the third cycle, Emily finally ovulated, but her progesterone levels were borderline, indicating weak ovulation.
Step 3: Moving to IVF—A Series of Setbacks
With time running out due to her age, Dr. Cole recommended in vitro fertilization (IVF) to bypass the unpredictability of ovulation and improve her chances of success.
1. Ovarian Stimulation
Emily began ovarian stimulation with high-dose injectable hormones. Initially, her ovaries responded well, producing 10 mature follicles. However, during monitoring, Emily developed ovarian hyperstimulation syndrome (OHSS)—a potentially serious complication of PCOS.
Symptoms included severe abdominal bloating, shortness of breath, and rapid weight gain. Emily’s egg retrieval was canceled, and she was hospitalized for five days to manage the OHSS.
Dr. Cole explained:
“OHSS is a risk for women with PCOS due to their heightened ovarian sensitivity. It’s a setback, but it doesn’t mean the end of treatment.”
2. Second IVF Attempt
After a two-month recovery, Emily tried IVF again, this time with a modified protocol to minimize OHSS risk. The retrieval yielded eight mature eggs, six of which fertilized. However, only two embryos made it to the blastocyst stage.
PGT testing revealed that one embryo was chromosomally abnormal, leaving Emily with only one viable embryo for transfer.
Step 4: A Heartbreaking Loss
The embryo transfer initially seemed successful—Emily’s pregnancy test came back positive, and her first ultrasound showed a healthy gestational sac. But at eight weeks, Emily started experiencing heavy bleeding and cramping. She rushed to the clinic, where an ultrasound revealed a miscarriage.
Emily was devastated. Dr. Cole encouraged her to take time to grieve and assured her they would refine the treatment plan for another attempt.
“Miscarriages are unfortunately more common in women with PCOS and those over 35,” Dr. Cole said. “But they don’t mean you can’t achieve a successful pregnancy. Let’s regroup and move forward.”
Step 5: A Hard-Fought Success
After a six-month break to focus on her mental and physical health, Emily tried a third IVF cycle. This time, Dr. Cole used a new ovarian stimulation protocol and adjusted her medications.
The cycle produced five mature eggs, two of which fertilized and passed genetic testing. Both embryos were frozen to give Emily’s body time to recover before transfer.
The first frozen embryo transfer resulted in a chemical pregnancy—another disappointment. Emily felt like giving up but decided to try her second and final embryo.
This time, the transfer worked. Emily’s pregnancy progressed normally, though she required careful monitoring for gestational diabetes and preeclampsia, both of which are more common in women with PCOS. At 39 weeks, she gave birth to a healthy baby girl via C-section.
Lessons from Emily’s Journey
Emily’s case highlights the complexities of treating severe PCOS in women over 35:
- PCOS Requires a Multi-Pronged Approach:
Lifestyle changes, medications, and advanced reproductive technologies all played critical roles in Emily’s success. - Setbacks Are Part of the Process:
From OHSS to miscarriage, Emily faced multiple challenges. Her ability to persevere and adapt was key to achieving her goal. - Egg Quality Declines with Age:
Combining IVF with PGT was essential for identifying healthy embryos and reducing the risk of miscarriage. - Emotional Support Is Crucial:
Emily sought therapy and joined a support group, which helped her cope with the emotional toll of her infertility journey.
Expert Insights
Dr. Cole reflected on Emily’s journey:
“Emily’s case demonstrates how individualized care can overcome even the most difficult fertility challenges. PCOS and advanced maternal age are not easy obstacles, but with persistence and the right team, success is possible.”
Final Thoughts
Emily’s story is a testament to the resilience required to overcome infertility caused by PCOS. Her journey was far from smooth, but each setback brought her closer to success. If you’re facing similar challenges, remember that solutions exist, even for the most complex cases.
Seek expert care, be prepared for twists and turns, and don’t give up—your family is worth fighting for.
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