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Needing a referral depends on your insurance. I didn't need a referral so I was able to call and get an appointment with my RE right away. Definitely call your insurance and ask them.

I was diagnosed as being "on the cusp" of PCOS with very little insulin resistance. I'm on Metformin, as per my RE. My OB wanted to put me on Clomid with no monitoring and I said no. My RE put me on 50 mg Clomid with monitoring and an IUI cycle. Clomid worked for me - I ovulated from two follicles but DH has male factor issues so we ended up doing IVF.

Good luck!

Honestly, I would go to an RE. They are more knowledgeable about infertility than an OBGYN, even if the OBGYN has a "specialty" in infertility.

It is only recommended to do 6 rounds of Clomid, I would want to know that I am getting the best possible chance especially if she is not going to be doing much monitoring.

ETA: I had Kaiser with my first RE so my OBGYN had to refer me, but she was able to do it as soon as I told her we wanted to TTC given my history with lack of a cycle. When I switched insurance companies at work I did not need a referral to my new office.

@bluestriped bee: me too...but I knew I had ovulation issues for years. My cycles have always been wonky.

@bluestriped bee: blood work and ultrasounds while on Clomid. I would ask them to check your A1C level every year. The RE checked mine in May 2012 and April 2014. The endocrinologist I saw for GD checked mine in April 2013 and September 2013. Lots of needles, haha.

@Hoots: Just go straight to an RE. If you have PCOS your best bet is to have monitored cycles. Your OBGYN is just not well equipped to handle this.

@Hoots: I completely agree it's best not to waste Clomid cycles. I'd find an RE. I love my RE and wish I could stay there throughout my pregnancy.

@Hoots: I have lean PCOS too and could go a year without a period . My family doctor at the time was no use at all and said all my hormones were normal and it was probably wedding stress. So I started going to acupuncture and he referred me to a fertility clinic who gave me options of femera, IUI and then maybe IVF. Anyway, acupuncture and herbs kick started my periods and ovulation and the clinic agreed to do one month of cycle monitoring, and I got pregnant with my daughter. The same thing happened a few months ago, but sadly I lost that pregnancy. No drugs needed either time. I never imagined that would be possible a few years ago.

So I guess my advice would be to start seeing an RE as soon as possible because they will look at everything, see the big picture and come up with a treatment plan for you. I also strongly recommend acupuncture, I swear it has worked wonders for me.

Good luck!

@Hoots: It is so hard trying to decide which route to take when it comes to treatment. My DH was against it too but he was against IUI even more (he would do it now though) so he let me try it and now he actually refers people to my acupuncturist, lol. It's not for everyone though. Whichever route you take, lean PCOS is treatable and hopefully you'll have your baby soon!

So i guess i have a different perspective...

I was diagnosed with Lean PCOS based on ultrasound showing cysts and 100+ day cycles that only ended with progesterone induced periods. My OBGYN ran bloodwork at two different times and everything always came back normal, so the lack of periods and the cysts were what categorized me as PCOS.

I started a low carb diet (not perfect... carbs are my weakness.. but i tried) and 1500mg of metformin every night. i got my period on my own for the first time 38 days after i started met, which was huge because the ONLY periods i got after going off of BC were progesterone induced. After that 38 day cycle, the next one was 40+ when i got impatient and asked for progesterone to start my period. Then for the cycle after the progesterone cycle i wanted to add clomid to the metformin so i took 50mg for 5 days and did OPKs to see if i ovulated. I got a positive opk, which was amazing because as far as i know i had never ovulated, and had good timing. My doc was going to have me come in for testing to "confirm" O, but i had to go out of town for work and missed the proper day for it. So i had no follicle monitoring and no O confirmation testing.

My OBGYN said he doesn't usually do monitoring because it ends up being expensive and it shows how many follicles you have to give you a heads up if you aren't going to O or if you have a higher chance of multiples (multiple follicles), but it doesn't actually treat anything, just gives you info sooner than an OPK would and is more expensive. So i was fine with no monitoring.

Turns out that one cycle of 50mg is all we needed! i got a BFP that cycle. The doc said if i would have gone 3 cycles (50, then 100, then 150) he would have referred me to an RE, but you're not really "wasting" clomid rounds by not monitoring because you're either ovulating or you're not, so clomid either works for you or it doesn't, so doing it under monitoring just confirms it earlier in the month vs an OPK or a BFP. If clomid isn't working for you, other treatment should be taken. So the monitoring can help you determine if you should go to other treatment sooner in a month, but does not really tell you anything different than just going through the cycle.

anyway, that's just another take on it. I certainly understand not wanting to wait, esp since things are taking longer than you want them to. I think it really depends on your insurance and your willingness to pay for testing to get info sooner in the month. I also think that as the cycles go on, it may be harder to wait if a prior cycle was unsuccessful, so you'd want as much info as possible as soon as possible

In short, i do not think your OBGYN is being irresponsible in saying they don't do monitoring, i think he or she is just taking a different approach with the level of info collected in each month and balancing it with the costs of that info.