Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Infertility
Question: Hi
I am 26, married from 3 years. TTC from 1.2 years. I have PCOS but my periods are regular. I went to doctor when i wanted to conceive. She told i am not ovulating and gave me ovulation injections for 6 months and told to have intercourse when i was ovulating. But i dint concieve. My gyn told since my husband's sperm count and motility is less its not working. She suggested to go for IUI. She did HCG before ivf and my tubes were clear. but my 2 IUI's failed she told it's because of low count and motility. Then she told to go for IVF. She did hysteroscopy before ivf and told my uterus is clear and absolutely no issues. She got 18 eggs in egg retrieval process. 16 were good among 18. All the 16 eggs were made embryos using ICSI. She told embryos are very good. She transferred 2 A grade and 1 B grade embryo in november 2013. Embryo Transfer In spite of everything being normal my fresh(first) IVF cycle failed. Then we thought of having break and we decided to go for FET in august 2014.
Now i am not on any medication but I gain weight after some 10 days after my periods and loose weight when period is due in 3-4 days. This weight fluctation was there from many years for me. I thought this weight fluctuation is because of pcod and my IVF failed due to it. I asked my doc regarding this but she told no it's not and she refused to give any treatment for it.
Before marriage once my periods was irregular and i had gained weight. My family physician gave me BCP for 3 months which regularized my periods and also i reduced a lot of my weight.
So keeping that in mind i started taking Duoloton-l in may 2014 thinking it would reduce my harmonal imbalance and my fet would be a success. but i dint consult my doc. But now i am getting afraid that Duoloton-l might cause issues. I have taken some 15 tablets till now. I am afraid to tell this to my doc because if my FET fail she might tell this as reason. So please help me.
If i stop the duoloton-l after getting my periods, I will have 2 months left to go for my FET. So if any side effects are caused because of duoloton -l will it be gone before my FET. Please help me. I beg you.
I am 26, married from 3 years. TTC from 1.2 years. I have PCOS but my periods are regular. I went to doctor when i wanted to conceive. She told i am not ovulating and gave me ovulation injections for 6 months and told to have intercourse when i was ovulating. But i dint concieve. My gyn told since my husband's sperm count and motility is less its not working. She suggested to go for IUI. She did HCG before ivf and my tubes were clear. but my 2 IUI's failed she told it's because of low count and motility. Then she told to go for IVF. She did hysteroscopy before ivf and told my uterus is clear and absolutely no issues. She got 18 eggs in egg retrieval process. 16 were good among 18. All the 16 eggs were made embryos using ICSI. She told embryos are very good. She transferred 2 A grade and 1 B grade embryo in november 2013. Embryo Transfer In spite of everything being normal my fresh(first) IVF cycle failed. Then we thought of having break and we decided to go for FET in august 2014.
Now i am not on any medication but I gain weight after some 10 days after my periods and loose weight when period is due in 3-4 days. This weight fluctation was there from many years for me. I thought this weight fluctuation is because of pcod and my IVF failed due to it. I asked my doc regarding this but she told no it's not and she refused to give any treatment for it.
Before marriage once my periods was irregular and i had gained weight. My family physician gave me BCP for 3 months which regularized my periods and also i reduced a lot of my weight.
So keeping that in mind i started taking Duoloton-l in may 2014 thinking it would reduce my harmonal imbalance and my fet would be a success. but i dint consult my doc. But now i am getting afraid that Duoloton-l might cause issues. I have taken some 15 tablets till now. I am afraid to tell this to my doc because if my FET fail she might tell this as reason. So please help me.
If i stop the duoloton-l after getting my periods, I will have 2 months left to go for my FET. So if any side effects are caused because of duoloton -l will it be gone before my FET. Please help me. I beg you.
Brief Answer:
do not worry
Detailed Answer:
Hello and welcome,
You are in a lot of stress. Please do not worry so much. The management of infertility is difficult and the success rate of IVF is also not 100%. In fact it varies from 30-40% in some centers. So a failed IVF cannot be always explained as even we do not know why it failed in many cases.
Duoluton is a contraceptive pill. It will not have any effect on the IVF if you stop it 2 months ago. The only issue is if you take it during the IVF cycle and no one will do it. So just stop it and do not worry about its effects.
About the weight gain and loss. These are not uncommon issues. They occur due to hormonal changes during the menstrual cycle and in most cases do not need any treatment. The best therapy for these is regular exercise which is very effective. There are other drugs but since you will be going for an IVF cycle these cannot be used now.
So just stop the tablets and the effect will wear away from your system in a few days. A period may come after stopping the tablets [ may be earlier than your expected period as this one will be due to drug withdrawl]. There is no need to worry about this period.
I understand your concern and not wanting to discuss it with your doctor. But as a gynecologist myself, I suggest that you talk this over with her as it is not recommended to conceal history from your doctor. I understand your position and also that you are scared. Take someone along with you during the consultation to help you feel better if needed. Remember that IVF is not successful every time and so a reason may not always be available.
Also duoluton will not have any effects on the cycle.
Also another issue is the low sperm count and IUI. If IUI was done after 6 months of attempting spontaneous pregnancy after stimulating ovulation with drugs then maybe it was a thin uterine lining due to repeated ovulation stimulation. So please check with this. You may also try a repeat IUI this time for pnecycle with a new ovulation induction. Also if the sperm count is low, then drugs like addyzoya, moxaza and clomiphene are used to improve counts and ask your doctor for these.
All my best wishes are with you.
Feel free for any further queries.
Dr Madhuri
do not worry
Detailed Answer:
Hello and welcome,
You are in a lot of stress. Please do not worry so much. The management of infertility is difficult and the success rate of IVF is also not 100%. In fact it varies from 30-40% in some centers. So a failed IVF cannot be always explained as even we do not know why it failed in many cases.
Duoluton is a contraceptive pill. It will not have any effect on the IVF if you stop it 2 months ago. The only issue is if you take it during the IVF cycle and no one will do it. So just stop it and do not worry about its effects.
About the weight gain and loss. These are not uncommon issues. They occur due to hormonal changes during the menstrual cycle and in most cases do not need any treatment. The best therapy for these is regular exercise which is very effective. There are other drugs but since you will be going for an IVF cycle these cannot be used now.
So just stop the tablets and the effect will wear away from your system in a few days. A period may come after stopping the tablets [ may be earlier than your expected period as this one will be due to drug withdrawl]. There is no need to worry about this period.
I understand your concern and not wanting to discuss it with your doctor. But as a gynecologist myself, I suggest that you talk this over with her as it is not recommended to conceal history from your doctor. I understand your position and also that you are scared. Take someone along with you during the consultation to help you feel better if needed. Remember that IVF is not successful every time and so a reason may not always be available.
Also duoluton will not have any effects on the cycle.
Also another issue is the low sperm count and IUI. If IUI was done after 6 months of attempting spontaneous pregnancy after stimulating ovulation with drugs then maybe it was a thin uterine lining due to repeated ovulation stimulation. So please check with this. You may also try a repeat IUI this time for pnecycle with a new ovulation induction. Also if the sperm count is low, then drugs like addyzoya, moxaza and clomiphene are used to improve counts and ask your doctor for these.
All my best wishes are with you.
Feel free for any further queries.
Dr Madhuri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your concern and brief response for my query. I am relaxed a bit now. As recommended I will start doing regular exercise/aerobics.
I have already taken 17 duoloton-l tablets till today. Do you want me to stop it now or take the left out 4 tablets?
My FET is in august 2014. Do you recommend me to undergo any specific hormone tests for successful FET? In my fresh IVF cycle in November the following tests were done before egg retrieval
1. Serum LH
2. Serum FSH
3. PROGESTERONE
4. ESTRADIOL
And after egg retrieval timely monitor of ESTRADIOL was done. After embryo transfer only PROGESTERONE was monitored.
Is this fine? Or any extra tests need to be done.
Regarding my IUI: As you told after continuous ovulation induction for 4 months my IUI was done for next 2 cycles without any break. Then we decided to go for IVF for which we took a gap of 2 months and Hysteroscopy was done 1 month prior to IVF.
During the follicular study my endometrical thickness was 11 mm (average) on the day of my egg rupture for the 4 natural cycles + 2 IUI
My gyn told me that my endometrical thickness was fine in all the cycles.
Is the endo thickness for implantation?
Do you suggest me to go for another IUI before FET (august 2014) since we have taken break from December 2014
And regarding sperm count and motility my husband took maxizo-l, q-gold and clomid (stopped after 3 months as suggested by gyn) for 5 months and stopped after our 2nd (last) IUI,
And his sperm count was 40 million and motility was 45% (sum of grade III and IV) when tested before IVF.
And I want to know whether my pcod playing a role in failure of my IUI and IVF?
And finally what is your opinion on FET success rate?
I have already taken 17 duoloton-l tablets till today. Do you want me to stop it now or take the left out 4 tablets?
My FET is in august 2014. Do you recommend me to undergo any specific hormone tests for successful FET? In my fresh IVF cycle in November the following tests were done before egg retrieval
1. Serum LH
2. Serum FSH
3. PROGESTERONE
4. ESTRADIOL
And after egg retrieval timely monitor of ESTRADIOL was done. After embryo transfer only PROGESTERONE was monitored.
Is this fine? Or any extra tests need to be done.
Regarding my IUI: As you told after continuous ovulation induction for 4 months my IUI was done for next 2 cycles without any break. Then we decided to go for IVF for which we took a gap of 2 months and Hysteroscopy was done 1 month prior to IVF.
During the follicular study my endometrical thickness was 11 mm (average) on the day of my egg rupture for the 4 natural cycles + 2 IUI
My gyn told me that my endometrical thickness was fine in all the cycles.
Is the endo thickness for implantation?
Do you suggest me to go for another IUI before FET (august 2014) since we have taken break from December 2014
And regarding sperm count and motility my husband took maxizo-l, q-gold and clomid (stopped after 3 months as suggested by gyn) for 5 months and stopped after our 2nd (last) IUI,
And his sperm count was 40 million and motility was 45% (sum of grade III and IV) when tested before IVF.
And I want to know whether my pcod playing a role in failure of my IUI and IVF?
And finally what is your opinion on FET success rate?
Brief Answer:
detailed answer below.
Detailed Answer:
Hello and welcome,
There are too many questions in this one and I will answer them one by one:
1. the tests are fine and none other are needed for IVF.
2. The endometrial thickness too is fine though anything above 12 -13 is more conducive.
Sperm count above 40 million are enough for an IUI or an IVF procedure and they are not of much consequence in your case.
The main factor with PCOD is the ovulation as well as hampering the implantation due to hormonal imbalances at the micro level. So we cannot be sure about this one as of now. An IVF is meant to counter all these so no point in blaming these for failure of therapy.
As of now, there are two options
1. Try an IUI now for one cycle only since you have stopped drugs since 6 months. If it fails take a rest for 3-4 months and then go for IVF.
2. Or another option is go for your IVF as planned as IUI has already failed. Please remember that stress also causes infertility. So if you think too much about therapy then the stress creates unfavorable environment for implantation. So please do not get stressed. Also you may take the duoluton for the remaining days if you want, it does not make a difference for me. But it is a contraceptive and so women attempting pregnancy are wasting time if this drug is taken as it deprives the chance of pregnancy in that month. So we do not usually prescribe it.
Also I am sure you must have been given progesterone in the IUI and IVF cycles to ensure proper endometrial thickness, please check if this was done and discuss this with your gynecologist for the next cycle.
About my opinion for success of IVF. I have already said that it varies from center to center and case to case. So women with certain conditions are more likely to fail and also certain centers have a better success rate due to better quality cultures and quicker interventions. PCOD is not a major issue. So please check the success rates at your center by discussing with other patients and also ask it clearly with the doctor. Remember that these are highly specialised procedures and so the success rates are not high. At every ladder of infertility management the success rates drop as the problem is more likely to be more complex and needs more therapy. So you must know this before hand. I understand that these are not very encouraging words but please remember that success rate of IVF itself is not 100% and so not every woman benefits. We therefore recommend to try initially with minimum drug interventions if possible.
Anyways, I also suggest that you get your body mass index evaluated and if it is high, decrease your weight very slowly and with the help of proper dietary counselling from a dietician. Also check the blood sugar and blood insulin test, blood testosterone and total androgens ( in fasting state preferably on day 2 of menses). If any of these are high then drugs like metformin and spironolactone are very helpful. So get these checked next month as this cycle is controlled by duoluton.
So as of now, just get tests tests done. Try natural conception in the next cycle ( use ovulation predicting kits if needed). Get the tests done and discuss the results with your doctor and may start any treatment if the results are abnormal. Then you may go for IUI or IVF as per the reports as well as after consulting your doctor and also a sound decision made after discussing with your husband.
All my best wishes are with you
Take care.
and I am here for any more queries.
Dr Madhuri Bagde
detailed answer below.
Detailed Answer:
Hello and welcome,
There are too many questions in this one and I will answer them one by one:
1. the tests are fine and none other are needed for IVF.
2. The endometrial thickness too is fine though anything above 12 -13 is more conducive.
Sperm count above 40 million are enough for an IUI or an IVF procedure and they are not of much consequence in your case.
The main factor with PCOD is the ovulation as well as hampering the implantation due to hormonal imbalances at the micro level. So we cannot be sure about this one as of now. An IVF is meant to counter all these so no point in blaming these for failure of therapy.
As of now, there are two options
1. Try an IUI now for one cycle only since you have stopped drugs since 6 months. If it fails take a rest for 3-4 months and then go for IVF.
2. Or another option is go for your IVF as planned as IUI has already failed. Please remember that stress also causes infertility. So if you think too much about therapy then the stress creates unfavorable environment for implantation. So please do not get stressed. Also you may take the duoluton for the remaining days if you want, it does not make a difference for me. But it is a contraceptive and so women attempting pregnancy are wasting time if this drug is taken as it deprives the chance of pregnancy in that month. So we do not usually prescribe it.
Also I am sure you must have been given progesterone in the IUI and IVF cycles to ensure proper endometrial thickness, please check if this was done and discuss this with your gynecologist for the next cycle.
About my opinion for success of IVF. I have already said that it varies from center to center and case to case. So women with certain conditions are more likely to fail and also certain centers have a better success rate due to better quality cultures and quicker interventions. PCOD is not a major issue. So please check the success rates at your center by discussing with other patients and also ask it clearly with the doctor. Remember that these are highly specialised procedures and so the success rates are not high. At every ladder of infertility management the success rates drop as the problem is more likely to be more complex and needs more therapy. So you must know this before hand. I understand that these are not very encouraging words but please remember that success rate of IVF itself is not 100% and so not every woman benefits. We therefore recommend to try initially with minimum drug interventions if possible.
Anyways, I also suggest that you get your body mass index evaluated and if it is high, decrease your weight very slowly and with the help of proper dietary counselling from a dietician. Also check the blood sugar and blood insulin test, blood testosterone and total androgens ( in fasting state preferably on day 2 of menses). If any of these are high then drugs like metformin and spironolactone are very helpful. So get these checked next month as this cycle is controlled by duoluton.
So as of now, just get tests tests done. Try natural conception in the next cycle ( use ovulation predicting kits if needed). Get the tests done and discuss the results with your doctor and may start any treatment if the results are abnormal. Then you may go for IUI or IVF as per the reports as well as after consulting your doctor and also a sound decision made after discussing with your husband.
All my best wishes are with you
Take care.
and I am here for any more queries.
Dr Madhuri Bagde
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi doctor. Thanks for answering all my questions.
What does testosterone and total androgen hormones indicate ?
My gyn has not tested these hormones till now.
Does these harmones affect the iui/ivf success ?
Can u suggest any specific diet plan (food) that I need to follow and also any specific food items which I need to avoid ?
What does testosterone and total androgen hormones indicate ?
My gyn has not tested these hormones till now.
Does these harmones affect the iui/ivf success ?
Can u suggest any specific diet plan (food) that I need to follow and also any specific food items which I need to avoid ?
Brief Answer:
glad that your queries are addressed to
Detailed Answer:
Hello XXXXXXX and welcome back,
Testosterone and total androgens are hormones that are higher in males and are present in small amounts in females. These are elevated in some women with PCOD. They are present in the follicles of ovaries that produce the female egg or ovum. If these hormones are high then the egg is not produced or not released due to local hormonal imbalance.
Drugs like spironolactone decrease these and help in decreasing the the imbalance and may help in ovulation. Regarding IUI and IV if androgens are raised then they may cause problems in growth of proper uterine lining and hence hinder implantation of the baby and also lead to abortions.
About the diet. Another problem with PCOD is the high insulin ( sugar lowering hormone). Despite the high insulin, tissues cannot use this insulin and so blood sugars are also high. So a diet that helps lower sugar helps also decrease insulin as less insulin is needed to control the higher sugars.
Citrus fruits are very helpful in this so eat oranges and lemons, limes daily in your diet plan. We advise to eat short meals that are complex and packed in nutrients but not calories. Start with a morning walk and have tea and 2 sugar free biscuits if desired in the morning. If you have tea with sugar then try changing it and use lemon juice or orange juice without sugar if possible.
Breakfast at 9 with an egg white or a cup of milk and sprouts, may take cereals if wanted. You may also substitute the sprouts and have them in lunch and take idli (2), or one dosa, 4 dhokla, or a bowl of poha or upma whichever you like.
Lunch at 1 pm with 2 multigrain chapatis ( make this atta at home with 250 gm ragi, 250 gm jowar, 250 gm moong dal and 1 1/2 kg wheat ground together. Adding a few methi XXXXXXX helps lower the insulin surge by lowering sugar), a small cup rice, a cup of vegetables and dal if you like. Salad can be had as much as desired. Similar but smaller portion of dinner with 1 chapati and rice can be had at 8 pm. A snack at 4 pm of fruit like orange, lemon, pomegranate, water melon or musk melon ( 2 slices) eat a portion of any of the above fruits. Avoid oil, fried food and any sweets and chocolates and ice creams. Evening walk is also helpful in raising the metabolic rate and helps lower the sugar and hence insulin. Less body fat helps lower androgens.
So try this plan and exercise regularly to help your hormone gain more balance.
Hope this was helpful. Feel free for further queries.
Dr Madhuri
glad that your queries are addressed to
Detailed Answer:
Hello XXXXXXX and welcome back,
Testosterone and total androgens are hormones that are higher in males and are present in small amounts in females. These are elevated in some women with PCOD. They are present in the follicles of ovaries that produce the female egg or ovum. If these hormones are high then the egg is not produced or not released due to local hormonal imbalance.
Drugs like spironolactone decrease these and help in decreasing the the imbalance and may help in ovulation. Regarding IUI and IV if androgens are raised then they may cause problems in growth of proper uterine lining and hence hinder implantation of the baby and also lead to abortions.
About the diet. Another problem with PCOD is the high insulin ( sugar lowering hormone). Despite the high insulin, tissues cannot use this insulin and so blood sugars are also high. So a diet that helps lower sugar helps also decrease insulin as less insulin is needed to control the higher sugars.
Citrus fruits are very helpful in this so eat oranges and lemons, limes daily in your diet plan. We advise to eat short meals that are complex and packed in nutrients but not calories. Start with a morning walk and have tea and 2 sugar free biscuits if desired in the morning. If you have tea with sugar then try changing it and use lemon juice or orange juice without sugar if possible.
Breakfast at 9 with an egg white or a cup of milk and sprouts, may take cereals if wanted. You may also substitute the sprouts and have them in lunch and take idli (2), or one dosa, 4 dhokla, or a bowl of poha or upma whichever you like.
Lunch at 1 pm with 2 multigrain chapatis ( make this atta at home with 250 gm ragi, 250 gm jowar, 250 gm moong dal and 1 1/2 kg wheat ground together. Adding a few methi XXXXXXX helps lower the insulin surge by lowering sugar), a small cup rice, a cup of vegetables and dal if you like. Salad can be had as much as desired. Similar but smaller portion of dinner with 1 chapati and rice can be had at 8 pm. A snack at 4 pm of fruit like orange, lemon, pomegranate, water melon or musk melon ( 2 slices) eat a portion of any of the above fruits. Avoid oil, fried food and any sweets and chocolates and ice creams. Evening walk is also helpful in raising the metabolic rate and helps lower the sugar and hence insulin. Less body fat helps lower androgens.
So try this plan and exercise regularly to help your hormone gain more balance.
Hope this was helpful. Feel free for further queries.
Dr Madhuri
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
