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Irregular periods, amenorrhoea, inter-menstrual bleeding, unable to conceive. Ultrasound done. Taking Duphaston, Clomiphene. Treatment?

Hi..Good to know this website...i ve been married for almost 3 years however my wife still ot pregnant. My wife has irregular menstrual cycle whereby her menses will lasted about 13-15 days every cycle. And for sometimes she became amenorrheic for 3 months however not pregnant. We seek medicl treatment during that time and she was given medicine to inuce her menses. After that her menses comes as usual but still 13-15 days and irregular still. she also took clomiphene for 3 cycles along with duphaston . However still not pregnant. But the best things it helps regulate her menses. Then after stopping clomiphene till now she is having irregular menses again along with intermenstrual bleeding . Ultrasound was done twice and she was told to have small fibroid . I really need your advice..
Asked On : Sat, 11 Aug 2012
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General & Family Physician 's  Response

Welcome to HCM,

It is possible that your wife is suffering with PCOD.

Patients suffering with Poly cystic ovarian disease have multiple small cysts in their ovaries.

Ovaries become enlarged and produce excessive amount of estrogen and androgen hormones.

Absence of ovulation causes infertility.

Many patients with PCOD also have insulin resistance and have raised level of insulin.

These patients may not respond to clomiphen, thus treated with anti diabetic drugs like metformin and troglitazone.
Clomiphen is used to stimulate ovulation. Low doses of dexamethasone can be given simultaneously to suppress androgen production from adrenal gland.

If clomiphen doesn't work, a new anti-estrogen called Letrozole can be used.

Clomifen resistant women suffering with PCOD, may need HMG(gonadotrophis) to induce ovulation.

Difficult patients may require a combination of GnRH analog and HMG to induce ovulation successfully.

Metformin can improve your fertility by reversing endocrine abnormality and improving your ovulatory response.

You should take her to a experienced Gynecologist for examination, investigations and treatment.

Thanks for trusting Healthcaremagic and posting your query.

Hope you found my response to your query informative and helpful.

If you have further concerns in this regard, you can submit those with Healthcaremagic as well.

With good wishes,
Answered: Sun, 12 Aug 2012
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