PCOS, High BMI, and Post surgical Scarring

Hi Robert,

I am in my late 20’s, have PCOS, and have started to try to conceive for the last couple of months.
For the last 5 years my periods have been reasonably regular, at approx every 7 weeks ish. I have had times of taking metformin due to struggling with weight loss, I am currently BMI 29.

18 months ago I had a ruptured appendix and was quite ill in hospital, which led to emergency surgery to place a drain and antibiotics, but the appendix was not removed. It was subsequently removed 5 months later. I have since had ongoing pain which has now been diagnosed as post surgical and post peritonitis pain.

This year, my periods have been very irregular, with only 4 this year and cycles varying from 50-90 days. I don’t know why the change, and if this is related to my ill health last year.

I have bought something called ‘ovusense’ which I don’t know if you know if this is useful or if theres much evidence for this being helpful in trying to conceive. It confirmed that on one cycle I ovulated at day 39, but in the next cycle which was 90 days long there was no ovulation. I am currently using it for the third cycle.

Basically, I am just wondering if you think that we should try to continue to conceive for a little while before seeking help, or do you think that its best to seek an opinion and potential tests early on (I know this would be private at this stage) to see if there is an issue? I’m just not sure on the change in my cycle and if this could be to do with adhesions/scarring from my surgery.

Thank you in advance,


Dear M.,

I must strongly urge you to continue to lose weight, because if you get your BMI two with in normal limits you almost double your chances of pregnancy either naturally, or using IVF.

In my view, in view of your history of inflammation and infection in the peritoneal cavity, I would strongly recommend a laparoscopy at this stage. It is very likely that the ruptured appendix and the infection which resulted, may have left you with adhesions. These are very commonly compromise the fallopian tubes and make it difficult to get pregnant. A laparoscopy should be done with photographs being taken as a permanent record of the damage you may have sustained. This will enable you to consider whether you should continue trying to get pregnant naturally on drugs to control the PCO, or whether you should consider IVF.

During the laparoscopy, it may be that the gynaecologist would consider doing a small operation on your ovaries (which you say are cystic). This might involve placing a needle in the ovarian cysts or possibly diathermy to the ovaries. This could make your ovaries a bit more responsive. But in my view, the urgent thing must be to lose weight because this makes the laparoscopy easier to do and the outcome more likely to be successful. A laparoscopy may also be helpful in assessing why are you still having pelvic pain and sometimes dividing adhesions around the ovaries during laparoscopy, gives some pain  relief.

My best wishes

Robert Winston