Brief Answer:
Kindly attach recent reports.

Detailed Answer:
Hello,

Thanks for writing to us on Healthcare Magic.

From your information, I can assume that you are both suffering from Primary Infertility for long time and your wife is now under treatment of PCOD (Poly Cystic Ovarian Disease) with metformin for last 6 months.

Before going to solve this problem, I need information of the following things:

1) Have you done any kind of fertility tests previously? If yes, kindly attach or upload all recent reports like semen analysis, ultrasound scan, hormone tests etc.

2) When does she last check her pregnancy status?? Is it urine or blood test?

3) Give information on previous menstrual cycle, current body weight, taking any other medication??

4) Do you consult with infertility specialist previously?? If yes, what is the cause identified by them for prolonged infertility??

Waiting for your valuable reply. Give detailed history and information, so that I can assist you better with proper treatment guideline.

Regards,
Dr Soumen

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Brief Answer:
Follow the guideline.

Detailed Answer:
Hello,

Thanks for your response and attaching recent test reports.

I have reviewed all attached reports. All things are within normal range except multiple cyst on both ovaries (PCOD).

Basic concept of successful conception is unprotected sexual intercourse with ejaculation close to the ovulation day (approx 14 days prior to next due date) or fertile days (12th to 18th day of each 28-30 days cycle). Regular period is an essential criteria to increase chance of pregnancy.

Here, we need to monitor her ovulation according to cycle with introduction of medication to get regular period. It is done through serial ovarian follicular study and ovulation prediction kit (available in medical store).

In such condition, I prefer to treat my patients with following regimens:

1) Ovulation induction drugs (like Clomiphene) : From D2/D3 to D6/D7 of each menstrual cycle for consecutive 3 months.

2) Progesterone supplement (like Duphaston or Deviry) : From D16 to D25 of each cycle. It will help to get regular period and increase chance of conception.

3) Insulin sensitizer (like metformin) : It is to be continued as previously.

In failed medical therapy, we prefer next line of treatment like laparoscopic ovarian drilling (surgical method). It has 80% proper ovulation rate and 50-60% pregnancy rate.

In addition, she needs to undergo follicular study to see overall follicle maturity and timing of ovulation. It is done mostly between D12 to D16 of each cycle. You can consult with your gynecologist regarding this if it is not done previously.

Above treatment protocols are to be continued for continuous 6 months and if she fails to conceive, then some additional tests like:
1) Patency test for fallopian tube (HSG or laparoscopy) to rule out tubal blockage
2) Test for cervical factor : PCT (Post Coital Test), ASA (Anti-sperm antibody)

Additional things to be followed in due course of treatment: 1) Regular physical exercise to reduce or control body weight 2) Avoid mental stress by meditation or yoga 3) Low carbohydrate diet with folic acid & vitamin-E supplements.

Last thing, as you have already spent 9 years after marriage, I suggest you not to waste too much time with treatment protocol. It is better to consult with Infertility or IVF Specialist to undergo Assisted Reproductive Technique (ART) for successful conception. It will be best choice at your stage.

Hope, above said information is sufficient & very much helpful. Let me know, if you need any clarification.

Wish your good health and take care yourself.

Regards,
Dr Soumen

For future query, you can directly approach me through
WWW.WWWW.WW

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