Hello XXXXXXX

Thanks for writing to us. I have gone through your past history and current medical reports.

First of ll, I want to comment on blood test reports. It suggests normal thyroid hormone level. Other hormones on day 2 of cycle are also in normal limit.

Now I try to give answer according to your query. These are following:

1) Fertomid is an ovulation induction drug and sometimes it may causes unusual vaginal bleeding/ spotting due to side effects of it.
It is not related to progesterone drop which is quite normal thing prior to ovulation. Progesterone level varies in different phase of cycle and it is lowest during period, slight high after ovulation and highest during pregnancy.
Other possibilities may be associated with spotting and these are stress/ anxiety, irregular eating habit, psychological factors, overweight or extreme weight loss.

2) In case of progesterone deficiency, the menstrual cycle goes on without ovulation. And if ovulation not occurs, then it is very difficult to conceive.
To diagnose corpus luteum function or progesterone deficiency, I suggest you to perform Day 21 progesterone assay and if it is more than 8 ng/ml (without fertomid) or more than 20 ng/ ml (with fertomid), then its normal.
Endometrial biopsy on Day 21-23 for observing secretory changes, caused by progesterone hormone following ovulation, is also helpful in addition to above.

Normally ovulation occurs approx 14 days before due date and it can be monitored by serial sonography on D12-D16 in addition to Ovulation Prediction Kit to get best result.

You should have to undergo for several investigations to rule out causes of past miscarriage. These includes TORCH profile, Blood gr & Rh typing of your husband also (to check Rh incompatibility), Blood sugar (PPBS), Test for chromosomal abnormality, Progesterone level after ovulation etc.

Please consult with your gynecologist for proper guideline of this investigations.

Intake of Folic acid & Vitamin -E supplements for at least 3 months in preconception period is very much helpful.

Do following basic things to improve her fertility:

1) Avoid stress by yoga/deep breathing regularly (20-30 times).
2) Take healthy diet with vitamin & iron supplements.
3) Drink plenty of fluids/water and eat leafy vegetables.
4) Maintain personal hygiene and sleep well
5) Control body weight by regular light exercise.

Hope I have answered your query. If you have any further questions I will be happy to help.

Wish good health for both of you.

Regards,
Dr Soumen.

---

Hello XXXXXXX

Thanks for follow up query.

The above blood reports including TORCH profile are within normal limit.

Please follow suggestive measures as described in previous reply.

If you do not have any clarifications, you can close the discussion and rate the answer.

Take care of yourself.

Regards,
Dr Soumen

---

Hello XXXXXXX

Thanks for writing to us.

Leptaden is an ayurvedic medication, used to increase milk in lactating mothers. Commonly there is no major side effect.

Spotting is possibly due to side effect of fertomid or associated with above said factors.

You should consult with your treating doctor regarding this and take suggestive measures.

If you do not have any clarifications, you can close the discussion and rate the answer.
Take care
Regards,
Dr Soumen.

---

Hello XXXXXXX

Thanks for follow up query once again.

On day 14, your blood reports for hormonal assay are within normal range and it suggests that you ovulated at that time.

Being positive pregnancy test with bleeding & mild cramp, it suggests early implantation bleeding or sign of miscarriage in later stage.

Therefore, it is better to do a Ultrasonography (USG) for lower abdomen or Trans Vaginal Sonography (TVS) to rule out the viability of the fetus and extent of miscarriage. TVS is superior in this case.

You may need Micronised Progesterone Tablet or Depot injection combined with Tranexamic acid to prevent miscarriage and support pregnancy. But these treatments are not always 100% effective.

Please consult with your gynecologist and take suggestive measures according to your test result

Do following things to prevent miscarriage:
1) Complete Bed Rest with foot end elevation by pillow preferably
2) Take Folic acid supplements and Protein XXXXXXX diet.
3) Avoid long journey/heavy work/stepping uneven surface/high heel shoe.
4) Avoid stress/anxiety/emotional upset & maintain personal hygiene.
5) Drink more water and eat leafy vegetables/ fruits.

If you have any further questions I will be happy to help.
Take care yourself.

Regards,
Dr Soumen

---

Hello XXXXXXX

Thanks for follow up. I am trying to give your answer.

According to ultrasound report, it seems to more possibly corpus luteum cyst which can give false positive pregnancy test with spotting. This type of cyst is more commonly associated with ovulation induction drug (fertomid). Though, these cysts don't prevent or threaten a resulting pregnancy.

On the other hand, an ovarian cyst never give false positive pregnancy test.

It is very early to say whether gestational sac will appear or not after finding corpus luteum cyst. Though, I suggest you to repeat the ultrasound or TVS scan after 2 weeks for better visualization & confirmation.

In generally, gestational sac is visualized around 4 weeks on TVS and around 6 weeks on abdominal ultrasound. So you can wait for at least 2 weeks for the scan.

As spotting is very much low, then you should follow above said suggestive measures strictly until you get fruitful result. Complete bed rest with folic acid & micronised progesterone medication are the mainstay of treatment in this stage.

If you do not have any clarifications, you can close the discussion and rate the answer.

Wish you good health and avoid stress.

Regards,
Dr Soumen.

---

Hello XXXXXXX

Thanks again for query. I am happy to help.

In a non-pregnant woman, value of beta HCG is less than 5 mIU/ml. But it is typically above 100 mIU/ml 14 days after ovulation in a healthy singleton pregnancy. So, in that sense, HCG level 141 mIU/ml indicates that you are pregnant.

On the other hand, corpus luteum cyst also elevates beta HCG level which can give false positive pregnancy test. Although cyst resolute automatically.

In this context, definite and surest investigation for pregnancy is one TVS scan and you shall do this after 2 weeks as early scan does not give detailed view.

In the mean time, you follow all above advice and avoid stress/emotional upset completely. Always hope for the best and keep up your spirit.

Take care yourself.

Regards,
Dr Soumen

---

Hello XXXXXXX

You are most welcome in XXXXXXX

Be well and stay healthy. I am also waiting for your good news.

If you do not have any clarifications, you can close the discussion and rate the answer.

Regards,
Dr Soumen.

---