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Dr. Andrew Rynne

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Have PCOD. Have had miscarriage. Trying to conceive. Fertility test normal. Required treatment?

Answered by
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Dr. Mahesh Koregol

Infertility Specialist

Practicing since :2000

Answered : 3768 Questions

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Posted on Wed, 12 Dec 2012 in Infertility Problem
Question: Patient of PCOD. Married for 2.5 yrs. Was on clomid for 6 cycles. Dint conceive. Conceived with Letrozol but had a miscarriage at 8 weeks. Its been a year since then trying to conceive but not able to. Both mine and husbands Fertility tests( Hormones, Tube test, Semen test, Karyotyping etc etc) shows normalcy. What could be the reason for not conceiving? I have a 33 day long cycle. I am on Metformin Hydrochloride 500mg thrice a day with folic acid. And from day 15 I am on Duphaston twice a day for 15 days... What do you think the next level of treatment should be? One of my Gynae says will try IUI but I am not convinced. My Husband doesnt have any issue so how would IUI help us? And another Gynae of mine has insisted on Laproscopy to clear my PCO condition and then try medications.. What do you suggest. I am really confused and worried...
doctor
Answered by Dr. Mahesh Koregol 28 minutes later
Hi, i read your query. I understand your concerns. Following is my reply: 1) Next treatment should be follicular growth scan by transvaginal ultrasound . This will predict accurate time to have intercourse. 2) IUI & laparoscopy may not be needed at this stAge. Please get follicular growth scan which should help you to conceive. Regards, dr XXXXXXX Koregol
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Mahesh Koregol 1 hour later
Thank you so much for your response Dr. I have been getting the folliculometry done around 3 times. once before my 1st conception and twice after my miscarriage. Based on follicular scan result, my follicles reach the maximum growth i.e.,19mm*22mm approx on day 17 and as slightly bigger on day 19. So I was asked to take HCG injections (last injection was 1000iu). Along with this my Duphaston is going on. Almost all my cycles have this rupturing injection taken. Dr asked me not to take any follicle inducing tablets for 2 to 3 months and try naturally. Without any tablets I had my follicle grown to 24mm on day 19 in the last cycle. Then I had taken HCG for rupturing on the same day. But that cycle was also failure... Now Dr has asked us to get relief from stress and tension. We both are into business... I stay near Nainital. I dont have proper medical guidance near the place where I stay... Dr, My Gynaes have told that we both are absolutely fine except that I still have PCO condition.. Then what needs to be done... Hope you understand under what pressure I am...:-( I really need your guidance...
doctor
Answered by Dr. Mahesh Koregol 3 hours later
Hi,

Thanks for your reply.

Its good to know you have done folliculometry and going on right track.

I recommend you to undergo folliculometry and Inj. hCG even when you are trying naturally as it gives you idea about day of ovulation and the chances of maximum fertility on those days.

Being mentally and physically stress free is a good option as per your doctor's advice.

You donot need laparoscopy as of now as you are ovulating ( even if delayed). Continue same way. PCO is not an absolute reason to have laparoscopic ovarian drilling.

Meanwhile try to keep your body weight under control. Increased weight leads to infertility and miscarriage.

Continue the metformin and follicular growth cans and try naturally for next 3 months. If you dont conceive go for IUI which is next step.

I hope I answered your query. I will be available for any followup queries you have.

Regards,

Dr.Mahesh Koregol
IVF & Infertility Specialist.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mahesh Koregol 42 hours later
Thanks again Doctor.

U know what I am a keralite. Born and brought up in Bangalore. Married in Delhi and now live near Nainital as we have Business.

I would like to ask couple of question which I have:-)

1) U are right. I was weighing 81Kgs and I have reduced to 66 now. I am on regular exercise,Yoga and pranayams. I think I will reduce somw more which inturn will help my fertility. Dr, should I be consulting a Gynae or should I consult an infertility specialist?

2) As I keep travelling by road (say 320kms once in 2-3 weeks) , will this affect my health?

3) Is there any food that I need to completely avoid For instance Coffee, raw papaya etc? Also should I be on rest from the day of ovulation till the next period cycle?

4) After intercourse sometime semen does not flow out but majority of the time it flows... Do you think we are going wrong in what we are doing?

5) And just confirming once again If IUI is my next level? And how do you think it will help me? Because I have heard that IUI is referred to couples where in the Mae has some issue...Please advise...

6) Also Last but not the least... Would you be able to advise if there is any good Gynae's in or around Delhi and Nainital areas? As you are in such a great position I am sure you would have lots of contact world wide....

I think I have been pestering you more.. But am really worried and confused DR:-(

Thank you once again for you patients, opt and timely answers for my questions....
doctor
Answered by Dr. Mahesh Koregol 58 minutes later
Hi,

Nice to know you are Indian who has experienced different cultures of India. I am happy to know you have reduced so much of weight. It will definitely help you in conceiving.

Following is my reply to your queries:

1) It will be better if you visit infertility specialist. They will give proper treatment.

2) Travelling may not affect your health. Try to avoid travelling during last 15 days of your cycle when implantation takes place.

3) No food needs to be avoided. There is no need of absolute bed rest. Do moderate work.

4) Keep a pillow below your hips before your husband ejaculates. This will prevent semen from flowing out. Dont get up immediately from bed. sleep for an hour. Dont wash with water inside vagina immediately. Just clean the surface with wetcloth.

5) IUI is logically next step. Nothing to do with only sperm count. It helps in unexplained infertility like yours.

6) See Dr. XXXXXXX XXXXXXX in Delhi. SHe is qualified IVF specialist. Quote my name. Her no. 0000

Dont worry. Feel free to contact anytime.

Regards,
Dr.Mahesh Koregol
IVF Specialist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mahesh Koregol 45 hours later
Thank U so much for your advise Dr. I shall surely get in touch with the Dr whom you have referred.

I shall get in touch with you if necessary.

Thanks again,
XXXXXXX
doctor
Answered by Dr. Mahesh Koregol 1 hour later
Hi, i wish you all the best. Please accept my answer. Regards, Dr. Mahesh Koregol
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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