Brief Answer:
Can go for HSG with proper precautions.

Detailed Answer:
Hi,

Thanks for posting your query.

I have gone through your husband's semen analysis. The assessment of progressive motility and liquefaction also should be done to see if there is any abnormality impeding the process of conception.

If you do not have regular cycles without medication, I would suggest completing all the investigations before going for active treatment as the results would be better and faster then with more information at hand. So, I would suggest going ahead with HSG under proper precaution to prevent any infection.

Trying blindly with ovulation inducing drugs is not advised for longer period. A course is usually given for six months before switching over to another treatment mode.

I would also suggest a complete work up to see the impact of hormonal imbalance and what corrections are needed. Insulin resistance, if present, can be corrected with Metformin and this in itself is sufficient to cause spontaneous ovulation.

Hope I have clarified your query. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
Several causes can be at play.

Detailed Answer:
Hi,

Thanks for writing back.

In PCOS, several factors can be at play and it is not enough to have ovulation through induction. There can be corpus luteal defect, creating deficiency in the ability to sustain a pregnancy should this happen and there can be other associated hormonal disturbances which also need to be corrected.

If you did not have all the investigations done, I would recommend you to undergo them through proper protocol. It is true that you did respond very well to the initial treatment by ovulating and this keeps the hopes high. Infertility treatment is all about patience and as such, please go through things patiently.

HSG is suggested as a routine and if you do not wish to get it done, you can get a trans-vaginal sonogram and go for a laparoscopic chromotubation if suggested. Any ovarian cysts can thus be identified and cyst puncture done. If there is a tubal block, it needs to be relieved and conception is not possible unless it is cleared.

Other factors that could be hindering conception inspite of ovulation are timing of intercourse, position of the uterus-a retroverted uterus is associated with lesser success, semen defects and anti-sperm antibodies.

IUI can be clubbed with induction and ovulation monitoring to aid in conception; this helps to overcome antibodies in the cervix and vagina, if present.

Maintenance of a healthy weight, regular exercise and avoidance of stress go a long way in controlling the hormone imbalance of PCOS in many cases.

Hope your query has been clarified. Please contact if you need any more information. I will be ready to help.

regards,
Shanti.V.

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