Patient: I am trying to get pregnant so I went to the ob-gyn. After running many exams (blood work as well as ovarian and uterine ultrasound) he verified that everything was normal, except that I had high levels of prolactin and so prescribed me with Dostinex (cabergoline) 0,25 mg per week. Also, he gave me Clomid to be taken for 4 cycles between the 3-7th day of each cycle.On the same week, I went to visit an endocrinologist. She ran lots of bloodwork and said I had metabolic syndrome because of my high colesterol and high triglycerides. She told me I could be having difficulty getting pregnant because of this and told me not to start clomid. She then gave me rosuvastatin for the cholesterol and metformin for insulin resistance, as well as a diet. I have been following the diet for over a month and already lost some weight. Nevertheless, I do not like the idea of rosuvastatin, as I heard that it has serious side effects and can cause liver damage, especially in asian populations.I would like to resume trying to get pregnant (I am 33 years old) and therefore I would like to interrupt the rosuvastatin since I heard It cannot be taken if you are trying to get or are pregnant.My question is: can I start taking the Clomid and interrupt the rosuvastatin? Should I interrupt the metformin or is it safe to use during an eventual pregnancy?My two doctors won’t agree. One thinks its safe to go ahead and get pregnant even after seeing all my bloodworm (he does not know I went to the endocrine and she gave me rosuvastatin and metformin). The other doctor says I should stop trying for now.I am running out of time to get pregnant and now is a window in my life in which it would be ideal.
Symptoms: Trying to get pregnant
Doctor: Hello,Thanks for the query to ATD for an opinion,As I learnt from the history that you were diagnosed to have hy perprolactinemia which is often a cause of delayed menses and anovulatory cycles and hence you have been advised cabergoline 0.25mg weekly. the levels of prolactin generally settle down by 3 weeks and ovulation can be expected from the next cycle onwards. If all other tests have been negative and there have been no polycystic features in ovary, then it’s a good sign indeed. However, it is a known fact that obesity if present ( BMI more than 25) then it again increases insulin resistance in the body which can deter ovulation again. So when your endocrinologist says that you have a metabolic syndrome he is right in his own way but when the concern is getting pregnant, then of course the opinion differs between gynaecologist and endocrinologist.You should stop rosuvastatin as its a hypolipidemic drug and as such is not a safe drug in pregnancy especially in early trimester if you get pregnant. You can continue metformin as its safe and cabergoline as well weekly. Clomifene can be started from next cycle as it shall help in follicular growth under an anovulatory environment ( preferred treatment even in cases of PCOS), so you should start without any concern. Weight reduction by 5% itself increases the chances of ovulation by 20% so keep your BMI in check.I hope i have answered your query and concerns in detail,Wishing you good health,Regards
Comments / Follow Ups
Patient: Dear Doctor: thank you for the detailed answer, it has very helpful . As per your recommendation, I stopped rosuvastatin and continue taking metformin (at lunch and dinner) + dostinex (once a week). Other than this, I took clomifene between days 3 and 7 of my current cycle. It gave my nausea and headaches, especially on day 15 of my cycle (8 days after my last climbed pill), when I had the worst headache I ever had. I also used the small pink strips (ovulation test) and had a faint line showing between days 14-16 (vs no line at all on the other days). Is it possible to have ovulated this cycle? I have been taking dostinex for over month now. Thank you once again.
It is to be understood that the first day when the ovulation tests shows two lines is the positive result and then in next 36 hours you should be ovulating ideally, which can be confirmed by an ultrasound transvaginally if a ruptured cyst is evident in the ovary ( if you have a facility nearby). I suggest usg confirmation is always better. If you have ovulated then you have high chances of conception in this cycle by natural intercourse. MAKE sure that the frequency of intercourse is high for next 7 days as higher the frequency of intercourse , higher the chances of conception. If you happen to miss your periods this cycle then perform a urine pregnancy test on the 7th day post missed periods to confirm or rule out pregnancy.
keep yourself well hydrated and that should take care of your headaches which are dehydration induced / often stress induced as well.