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Suggest Treatment For Difficulty In Conceiving

Posted on Fri, 11 Mar 2016

Question: 5 - 6 days of positive ovulation testers... Could it be perhaps that I'm ovulating more than once in the month as opposed to PCOS? And hence the 6 or more days of positive LH surge detection?

Does the 6 day long surge mean that I also have a luteal phase defect?

What are the chances of concieving a child naturally with PCOS? And the chances of conceiving with fertility help? FSH levels are extremely good with levels below 5. All other hormones are within the normal range except SHBG being high well over 176.

Also should let you know that I had a blood test last year in April to test for the Anti-Mulluran Hormone in my blood and the result was 5.8 pmol / L, so 0.83 ng / ml approx. Im 28 years old, turning 29 years old this May...can you please tell me how many years of fertility do I have left before my eggs run out? Bare in mind I had the AMH test last year in April 2015. So a year has almost passed already... and will PCOS have a negative impact on my fertility window? I need to know a rough time I have to conceive. A year or two?

Can a second uterus be hidden from a transvaginal ultrasound?

Answered by Dr. Deepti Verma (51 minutes later)

Brief Answer:
Do not panic

Detailed Answer:
Hi dear,
As discussed in our previous conversation, the prolonged positivity in ovulation kits is likely due to increased LH levels in the body.
Ovulation cannot occur multiple times in one menstrual cycle.
Luteal phase defect is due to decreased progesterone secretion after ovulation, and it has no association with prolonged ovulation kit positivity.
PCOS patients do conceive naturally, when the ovulation occurs, but it is rare and unpredictable.
Therefore, fertility drugs like clomiphene citrate are given to increase the chances of ovulation and hence increase the chances of conception.
Fertility of a women is average up to 35 years of age, after which it starts to decline.
Since your AMH levels are normal, there is nothing to worry regarding fertility potential.
PCOS has minimal effect on the fertility window.
You can conceive up to 40 years of age.
No, a transvaginal ultrasound gives a very clear picture of all the uterine cavities and its surrounding structures.
I suggest you not to stress out so much, and consult an infertility specialist to get properly examined, and get appropriate treatment so that you can conceive as soon as possible.
Hope you found the answer helpful.
I hope I made the things more clear now.
Please do get back for further queries.
Wishing you good health.
Regards
Dr Deepti Verma
OBGYN
Maternal and fetal medicine specialist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepti Verma (8 minutes later)

I ve been seeing a fertility specialist, i ve already undergone fertility drugs such as clomid but it created too many eggs that clumped together and expelled within two weeks of a positive pregnancy test.

Iam from Australia and my AMH result reads: Dimished Ovarian Reserve. So I have an extremely low ovarian reserve.

So now how does this affect me? An AMH blood test is supposed to be an insight into how many eggs a women has left in her ovarian reserve and therefore being able to determine how many fertility years she has left, so why hasnt any doctor been able to tell me? Its 5.8 pmol / L and the pathologist and my fertility specialist have both stated I have a LOW OVARIAN RESERVE. Someone my age should be above 14 pmol / L.

Answered by Dr. Deepti Verma (16 minutes later)

Brief Answer:
IVF

Detailed Answer:
Hi dear,
Your AMH levels are low.
However, AMH levels do not give correct prediction of ovarian reserve in patients with PCOS.
However, if you have taken ovulation induction drugs and failed in a successful pregnancy, then with this low AMH levels, I will suggest you to go for in vitro fertilization( IVF).
You should be given DHEA supplementation for decreased AMH levels and then go for IVF using a proper protocol.
You should not loose hope and be optimistic.
Regards
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Deepti Verma (7 hours later)

Would a DHEA be a good idea for me? As I already have high levels of SHBG. Wouldn't a DHEA further increase my SHBG levels? All other hormones are within range. I do need to mention that about two months ago I was lactating from my left nipple. On examination and testing the substance from my breast was in fact milk and not an infection of any kind.

Also I would love to do IVF however my partner is currently serving a term of imprisonment and has a further 18 months to go.

I to also have a prior criminal record for petty crimes however no matter how minor the offences were I still have a criminal record none the less and legislation in my home state (Victoria, Australia) clearly makes it unlawful for any person with a criminal record to engage in any assisted fertility procedured such as IVF and artificial insemination. Even if a person can't conceive natually due to medical conditions impacting reproductive health and such treatments such as IVF are simply DENIED. So I unfortunately have no where to go and time is running out.

Answered by Dr. Deepti Verma (4 hours later)

Brief Answer:
Please furnish some imformation

Detailed Answer:
Hi dear,
DHEA supplementation helps the egg recruitment in patients with low AMH.
It does not increase the levels of SHBG.
Milk discharge from the breast can be due to increased prolactin hormone levels and hyperprolactemia is one of the cause of irregular ovulation and difficulty in conceiving.
Have you done your prolactin levels?
Is it normal?
Is it allowed to have sexual relationship with your spouse once he is imprisoned?
If not, are you planning to conceive with donor sperm?
Please clarify the above points so that I can help you better.
Regards
Dr Deepti Verma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar