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Suggest Treatment For Infertility

Posted on Sat, 5 Apr 2014

Question: Hi my name is XXXX ,am married for 2years 8 months now. I had to suffer from miscarriage once in the month of XXXXXXX 2013. The doctor advised us not to try for a baby for 3 months and prescribed few medication(Ovacare,FOL123)which we followed. Since October last we have been trying for a baby but in vain. Last month my I did go through Follicular study scan which suggested it was all normal.The doctor also prescribed ovacare and Gestafine-100mg.I was supposed to get my periods on 7th of this month but it started as spotting from 9th march ,when i reported this my doctor she asked me to stop taking Gestafine and asked me to come once the flow starts.The flow has started normally from 10thMarch . Thanks.

Answered by Dr. Dattaprasad (35 minutes later)

Brief Answer: Few details required. Detailed Answer: Hi XXXXXXX Welcome to HCM. For advice regarding further management few details are required. Kindly provide following details. 1. How are your menstrual cycles without medicines (Regular/irregular, frequency of cycles ?28-30days). 2. Whether husband's semen analysis was done anytime, if yes what was result. 3. Whether first pregnancy happened after treatment OR naturally? How many months you had tried before first pregnancy. 4. Details of first miscarriage: Gestational age at which it occurred, whether baby's heart beat was seen on ultrasound scan, how was pregnancy terminated - with medicines/D & C? 5. What treatment for fertility you have taken till now. Awaiting reply. Regards.

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

Follow up: Dr. Dattaprasad (1 hour later)

1. My periods are regular,its usually 28 days once it was 27days and 29days 2. No he never had analysis 3. First pregnancy happened without any OR treatment and got positive results after 2 months 4. Gestational age according to the report was of 5weeks (result :- 307.4mIU/mL).The first scan report stated gestational age by LMP :6weeks 4 days,and after few days i noticed spotting when i contacted doctor she gave me Susten injection and also susten-200mg capsule one per day and asked to come for one more scan by then pregnancy had got terminated naturally no medicine was given 5. I have not taken any treatment for fertility till now

Answered by Dr. Dattaprasad (40 minutes later)

Brief Answer: Just do semen analysis. Detailed Answer: Hi, Welcome back. For pregnancy to occur three things are required: Normal semen, regular ovulation & patent tubes. As your periods are absolutely regular & you had conceived once in past, it implies regular ovulation & no test should be needed for that. Also as you had conceived in past, we can consider tubes to be open until proved otherwise (if you had history of pelvic infection: Fever associated with foul smelling vaginal discharge & lower abdominal pain, you need to check for tubal patency. Otherwise not needed). Third important thing is husband's semen analysis. Although you had conception in past, occasional pregnancy resulting in abortion can occur with low sperm count (OR low sperm quality). So what you need is one semen analysis after 2-3 days of sexual abstinence. If it comes to be normal, in my opinion you should not need treatment for conception (you should be able to conceive naturally without any intervention including follicular study). What you require might be little progesterone support (what you already received during last pregnancy in the form of susten injections & capsule) immediately after pregnancy is diagnosed (immediately after missed period) to prevent abortion. Kindly continue Folic acid tablets. Kindly get the semen analysis done & get back with report. Let me know if you have other concerns. Regards.

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

Follow up: Dr. Dattaprasad (23 minutes later)

Thank you doctor for the detailed info. We would get back to you with Semen analysis report. Thanks. XXXX

Answered by Dr. Dattaprasad (1 hour later)

Brief Answer: Welcome. Detailed Answer: You are most welcome. Regards.

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

Follow up: Dr. Dattaprasad (7 days later)

Good Noon Doctor.. I have the Semen Analysis report ready. I have sent the attachment to Healthcaremagic team. They would in turn send the report to you. Looking forward to the advise once the report reaches you. Thanks, XXXX

Answered by Dr. Dattaprasad (4 hours later)

Brief Answer: Report normal. Detailed Answer: Hi, Welcome back. Your semen analysis report is absolutely normal. As I already told, you can safely try naturally for 3-4 months without any intervention (including follicular study). She can continue Folic acid (and Ovacare) tablets. What she needs is progesterone support immediately after period is missed & that should be sufficient. (One miscarriage, that too, occurring so early during pregnancy doesn't warrant detailed investigations). One general advice regarding conception is to have intercourse at least 3 times a week (alternate days) irrespective of fertile period & to have it daily during fertile period (From 10th till 18th day of cycle: day one counted from the day of start of menstrual flow). If you don't conceive in another three months after trying naturally, we will think about any intervention required. Wish you all the best. Kindly get back if you have any other query. Regards.

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