Brief Answer:
Menstrual irregularity needs to be addressed

Detailed Answer:
Dear XXXXXXX

I have gone through your nicely narrated menstrual history. I will get back to your question about pregnancy after brief narration and some questions.

This history clearly suggests that there is irregularity in your menstruation. You have missed your periods in between. In February 2015 you had missed your period. In XXXXXXX and July 2015, the periods are not regular with proper bleeding.

I would like to have your serum FSH & LH levels repeated around 14th day.

Have you monitored the ovulation by ultrasonography? What are the reports?

Please get examined internally from a gynaecologist to find out whether you have any vaginal discharge and/or infection which can damage the sperms. Also I would request you to get your Post Coital Semen Examination. In this test, the semen is collected from the vagina after the intercourse for laboratory examination. This test reveals whether the sperms are getting damaged in your body.

Please try to understand that at the age of 39, the quality of eggs is not of a high level. However, the women can conceive even at this age.

Please upload all your and your husband's previous reports and the reports of newly suggested investigations by me. After viewing the reports, I would be able to guide you further after viewing the reports.

Monitoring egg release by ultrasonography and planning the intercourse accordingly is a very good way to success when all other investigations are normal.

I have given you few suggestions based on the information you have provided me. With more information as requested by me, I can opine further more.

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Brief Answer:
Some more information is required, please.

Detailed Answer:
Dear XXXXXXX

If this is the only you have, it does not give me all the information I want.

Will you please elaborate or upload the images and results of your Post Coital Semen Examination and Ultrasonohraphic Ovulation Monitoring at least in order to give me some idea about sperm antibodies and ovulation?

I have also realized that when you were on acupuncture, your menses were disturbed. Let us hope that they become regular gain after you have discontinued acupuncture.

Dear XXXXXXX I do want to express my opinion on your problem, however, some more information is required. Will you please furnish me the requested information?

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Brief Answer:
Ovulation monitoring may help you to conceive

Detailed Answer:
Dear XXXXXXX

I understand that you do not have the information readily available with you from all the previous investigations? Is it possible for you to get few new investigations done?

Meanwhile, I am suggesting you following:

Please try to locate the day of your egg formation (ovulation). In good old days, there were number of indirect methods like BBT for this. However, now with the modern gadgets and advance techniques, we have got methods to spot the egg formation directly. Ultrasonography helps us in collecting the evidence.

You will have to submit yourself for Ovulation Monitoring by Ultrasonography from day 9 of your cycle. Everyday, you will be informed about the progress of follicle and endometrial thickness. Usually the follicle ruptures and the egg is released after the follicle crosses its diameter of 18 mm. This is usually 14 days prior to next expected menses. So if you plan your sexual intercourse accordingly, the chances of success are quite high.

If the follicle does not rupture even after it attains diameter of 21 mm, then the chances of healthy egg and pregnancy are low. If it happens repeatedly, then your Gynaecologist may opt to induce the egg release at 18 mm size by giving hCG injection.

I think, with the available information that you have provided, I can suggest you this much.

Please reconsider whether you can get the other investigations I have suggested performed and inform me.

I am awaiting your positive response.

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Brief Answer:
You may try it for few cycles

Detailed Answer:
Dear XXXXXXX

The Clearblue Fertility Monitor is an equipment which helps you to predict the ovulation by hormonal levels. It is an indirect method of anticipating day of ovulation. It is a fairly good and accurate tool. You may make use of it.

However, it does not provide you any information about the size of follicle, the number of follicles, etc. though it can be inferred indirectly by hormonal ranges.

Since you had irregular menses for last few months you will have to wait till your menses are regularised for a couple of months before you start using this fertility monitor.

If this tool does not give you results within few trials, I would urge you to shift to ultrasonographic ovulation monitoring which will reveal even the size of the follicles and prompt for any intervention required.

Good, you have informed me your weight. That seems to be the problem. However, you are working on it. Please understand that it could be PCOS problem. However, you have mentioned that PCOS is ruled out.

And lastly, I would again request you to find about any hostile atmosphere inside your vagina for the sperms. Sometimes, vagina may have antibodies or any other factors which are hostile for sperms. In such cases, if those factors cannot be taken care of, intrauterine insemination or in vitro fertilization may have to be tried.

For any further information I am always available for you XXXXXXX I would appreciate if you provide me more detailed information which I had requested you previously.

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