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Why is my wife unable to conceive after miscarriage ?

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Practicing since : 2001
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Hello Dr, We have been trying for baby for 1 year. My wife has PCOS problem, 6 months ago she got pregnant with Letovel 2.5mg (3-7 days) and HCG 5000. Then she miscarried at 8th week. Last cycle, she taken letovel 2.5mg (3-7 days) and undergone follicle study, the egg was keep growing doesn't ruptured. So gyn advised her to take letovel 10 tablets (3-7, twice a day). Yesterday, i.e. 15th day of her cycle egg was grown 31 X 20mm. Doctor says, egg is good quality, it may get rapture naturally in a day or two so we can try this month without HCG, However, Me & my wife bit nervous about whether egg will get ruptured naturally or not? (As in past, it doesn’t happened). I'm wondering, why the egg is not rupturing even its in good quality? And, If she got pregnant again, (may be with or without HCG shot), what are all the precaution steps/checkups/medicine we should consider to avoid early miscarriage? BTW: my semen analysis was normal. Please advice.
Posted Sat, 14 Apr 2012 in Infertility Problem
Answered by Dr. Rakhi Tayal 1 hour later

Thanks for writing to us.

In cases of ovulation induction, the follicular size between 20-24mm is considered good enough to cause a successful ovulation. Usually inj. HCG is given at the follicular size of 18mm and the follicle ruptures after around 38 hours of injection when it reaches a size of 20-22mm.

In your case the largest follicle is already 31mm in size and can rupture anytime as it is fully mature.
Even with the best of efforts and ovulation, the successful rate of pregnancy is 16-18% per cycle. So, you need not be hopeless if there is inability to conceive even after getting such good size follicles.

Once she gets pregnant she needs to have progesterone supplements and adequate rest along with folic acid supplements under the guidance of her gynaecologist.

I hope my answer and recommendations are adequate and helpful. Waiting for your further follow up queries if any.

Wishing you good health.

Above answer was peer-reviewed by
Follow-up: Why is my wife unable to conceive after miscarriage ? 1 hour later
Thank You for your answer Dr.

Is there particular reason for not ovulating though egg reached its matured level? I mean any hormonal problem?

Previously, she got pregnant by using Letovel 5 tablets and HCG shot for ovulation induction. So, I think she had low HCG to induct ovulation naturally, Since its low she may be unable sustain her pregnancy after that, BTW: Last time during pregnancy she had taken progesterone and folic acid supplements.

Do we need to monitor HCG level after pregnancy? If so, From when we should keep track of HCG level after pregnancy? Sorry Dr. we are little scared about another miscarriage.

If she get pregnant using Letovel & HCG shot, baby will be healthy?
Answered by Dr. Rakhi Tayal 7 hours later

Thanks for writing again.

There is no particular reason for an egg not to get fertilized after it is released; or non release of egg after it is mature. It does not necessarily mean that there is a hormonal problem.

HCG levels do rise in every pregnancy and their levels double every 48 hours. Still if you have doubts in your mind regarding HCG levels you can take the supplements this time.
HCG levels start rising as soon as one week after ovulation.

The letovel and HCG are safe for the baby and do not produce any adverse effect on the baby.

Hope my answer is helpful.

Wish you good health and success.

Above answer was peer-reviewed by
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