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PCOD patient. Taking Metformin. Had HSG test. Chances of conceiving naturally?

Mar 2013
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My TSH is 4.38. Is this too high to get pregnant? I am also a PCOD patient, having Metformin 500 mg every day. I have a regular cycle with cycle length being 32-34 days.
Also, I had my HSG test recently. The impressions noted are "Both tubes are patent and spill observed in both", however my fimbrial ends in both the tubes are clumped and so been given a category 2A.

What are my chances of conceiving naturally?
Posted Thu, 15 Aug 2013 in Pregnancy
Answered by Dr. Aarti Abraham 52 minutes later
Thanks for writing to us.
Your TSH is not at all ' too ' high.
However, as per recommendations, you should ideally have a TSH less than 2.5 in the first trimester.
Please ask your endocrinologist to adjust your dosage accordingly.
Also, with PCOD and tubal problem, chances of conceiving naturally are not very high.
HSG is not the ideal test to ascertain tubal patency, a hysteroscopy and a laparoscopy is a must in your case.
It will specify the nature and extent of damage, and it sometimes at laparoscopy, surgical correction can be attempted for the clumping of the fimbrial ends.
PCOD patients frequently have difficulty in ovulation.
Ideally, a cycle of follicular monitoring should be attempted after your TSH value is under ideal range.
If ovulation problems are observed , then you might require therapy with ovulation inducing agents like Clomiphene citrate.
Ideally, the stimulation with clomiphene should be done after your laparoscopy.
Your partner's semen analysis is also a must.
Hence, to go step by step -
1. Go for a hysterolaparoscopy , simultaneously attempting to bring your TSH still lower, under guidance of your doctor.
2. Once the TSH is normal, and tubal status has been assessment, go for follicular monitoring followed by clomiphene stimulation.
3. If upto 6 cycles of Clomiphene + / - injectable stimulation fails, then you might need the help of ART ( assisted reproductive techniques ) to help you conceive.

Do not give up hope, as the treatment is long and complex, however at the age of 30 , chances of conception are good, with proper management.
Needless to say, please take regular folic acid supplements, exercise and eat well, as weight loss and lifestyle modification are key to treatment of PCOD.

All the best.
Please feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: PCOD patient. Taking Metformin. Had HSG test. Chances of conceiving naturally? 24 minutes later
Hi Dr,

Thanks for your answer. I have had 2 cycles of follicular study before and the doctors concluded that I ovulate on my own without any issues and CD18 is when I have ovulated during those cycles. The study was done during my natural cycle and not induced.

I am concerned when you say HSG is not the ideal test to assess tubal patency. The radiologist who did my test said everything looked fine, the report also says that both tubes are patent with free spillage seen in both tubes. However, the only thing in the report that did not sound normal to me was my clumped fimbrial ends. Is this a serious condition? Do I really have a tubal problem?

Answered by Dr. Aarti Abraham 1 hour later
See, HSG only evaluates the tubes from the OUTSIDE.
A laparoscopy actually looks at the tubes under direct vision and can tell you the cause of the clumped fimbrial ends.
Due to infection, or other pathologies, the fimbrial ends get clumped.
The fimbria are actually responsible for picking up the egg, and fertilization between sperm and egg also takes place in the tube.
IF the fimbrial ends are clumped, then chances are that the task of ovum pickup is not up to the XXXXXXX resulting in difficulty in conception.
As ovulation is not an issue with you, I would recommend a laparoscopy - that will provide a specific picture of the tubal damage, and also a chance for any surgical correction.
After 2 cycles of follicular study, a laparoscopy is definitely in order.
Take care.
Above answer was peer-reviewed by
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