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Dr. Andrew Rynne

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Dr. Sree Gouri SR

OBGYN

Practicing since :2006

Answered : 5164 Questions

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Posted on Mon, 23 Nov 2015 in Infertility Problem
Question: HI DOCTOR


I AM 29 YEARS OLD F. 2 YEAR BACK GOT MARRIED. LAST 1 YEAR WE TRIED FOR CHILD. NOW AFTER DOCTOR CONCENTRATION AND TEST I KNOW THAT
I HAVE:
1. BILATERAL POYCYSTIC OVERY.
2. Hsg IS OK.
3. HUSBAND SEMEN NORMOZOOSPERMIA.

MY CYCLE LENGTH IS APROX 36 DAYS.

LAST 4 MONTHS I AM TAKING INFERTILITY TREATMENT.

1 ST MONTH:
HUMOG 75 INJECTION (HMG 75I.U.) D1;D3
GOODOVA 50MG (ENCLOMIPHENE) D2 to D6
DUPHASTON 10MG 2/DAY (DYDROGESTERONE TABLET IP) D20 to D34.
NO USG DONE.

2ND MONTH:
HUMOG 75 INJECTION (HMG 75I.U.) D1;D3
GOODOVA 50MG (ENCLOMIPHENE) D2 to D6
D9: FOLICLE SIZE 10MM ET 4.3
D18 FOLICLE SIZE 20MM ET 5.5
D18: 10000IU HCG
DUPHASTON 10MG 2/DAY (DYDROGESTERONE TABLET IP) D20 to D34.

3ND MONTH:

CCQ 50MG D2 to D6
D9: FOLICLE SIZE 10MM & 11 MM ET 5.6MM
D9: HMG 75I.U
D11: FOLICLE SIZE 15MM & 16 MM ET 5.6MM
D11: HMG 75I.U
D14: FOLICLE SIZE 19MM & 20 MM ET 5.6MM
D14: 5000IU HCG

4 TH MONTH:

NO MEDICINE NO USG.
PERIOD IN DAY 50 TH AND HEAVY PERIOD.

5 TH MONTH

D4: HMG150IU.
D7: HMG 150IU.
D9: HMG 150IU, FOLLICLE 10MM 2 NO IS LH 2NO IN RH. ET: 8.1MM
D10: HMG 150 IU
D12: TODAY FOLLICLE 14MM, 13MM IN LH. IN RH 12 MM. ET: 9.3MM
TODAY I AM TAKING HMG 75IU.


PLS HELP AND ADVISE for further. please anss very briefly.
doctor
Answered by Dr. Sree Gouri SR 55 minutes later
Brief Answer:
Good ET this time

Detailed Answer:
Hi,
Thanks for the query.
I understand your concern.
In policystic ovary disease, we can see hormonal imbalance which can lead to irregular periods, annulation, infertility etc.
In your previous cycles, ovulation induction and hormonal supplementation during second half of the cycle has been given.
But usually we will expect more than 9 mm of endometrial thickness when the follicle reaches around 18mm size.
This was lacking in your previous cycles.
But in present cycle after taking periodic HMG injections, your ET thickness is good along with the size of ovarian follicles.
So, possibly you may conceive this time if all other parameters are normal, by following your doctor's advice.
Take care.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Sree Gouri SR 1 hour later
D4: HMG150IU.
D7: HMG 150IU.
D9: HMG 150IU, FOLLICLE 10MM 2 NO IS LH 2NO IN RH. ET: 8.1MM
D10: HMG 150 IU
D12: TODAY FOLLICLE 14MM, 13MM IN LH. IN RH 12 MM. ET: 9.3MM
TODAY I AM TAKING HMG 75IU.

MY QUESTION IS NOW:

1. ABOVE HMG DOSE IS OK/ OR NOT. IF I TAKE HMG 75 FROM D5-D9 DAILY THEN IS IT BATTER?
2. I WILL GO FOR USG ON D14. ANY HMG REQUIRED ON D 13. IF YES THEN 75/150?
3. HCG DOSE OF 10000 OR 5000 IS BETTER FOR ME WHEN FOLICLE REACH ABOVE 18.
4. U MENTIONED "So, possibly you may conceive this time if all other parameters are normal" WHAT ARE THE OTHER PARAMETERS, PLEASE MENTION HOW CAN I KNOW AND MAINTEN THAT.

5. WHEN CAN I START PRAGNANCY TEST AT HOME.
6, IF I PRAGNENT THIS MONTHS, WHEN SHOULD BE THE PROPER TIME FOR NEXT USG.
7. PLEASE SUGGEST ANY THING FOR INCREASE THE CHANCE OF PRAGNANCY THIS MONTHS.
8. ANY INTERCOURSE METHOD CAN U SUGGEST FOR BATTER RESULT.
9. I AM VERY FRUSTRATE IS THIS LAST ONE YEAR. PLEASE HELP ME TO GIVING THIS ANSWER.
PLEASE HELP.
doctor
Answered by Dr. Sree Gouri SR 1 hour later
Brief Answer:
Be hopeful

Detailed Answer:
Hi,
1. As your endometrial thickness and follicle development are good and as you have already taken four doses of 150 IU HMG injections, present dose is OK for you.
2.You may not need another dose on 13th day. But, if your doctor advices you may take according to her advice, 75 IU is preferable.
3. If previously follicle rupture was achieved with 5000 IU of HCG, that is sufficient. If not, better to choose 10,000 IU.
4. All other parameters means normal seminal parameters at the time of intercourse, planning intercourse at the time of ovulation, postovulatory normal progesterone levels, normal endocrine function etc. Your doctor can help in maintaining the normal progesterone levels by supplementing them.
5. You can go for urine pregnancy test after 4 to 5 days of missed period.
6. You can go for ultrasound at around 5 to 6 weeks after last menstrual period.
7. Taking medicines as advised by your doctor and following her instructions can help in increasing the possibility of pregnancy.
8. Better to be lying down position for around half an hour to 45 minutes after intercourse, which will help in ascent of spermatozoa.
9. As there is solution for every problem, be hopeful.
Take care.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Sree Gouri SR 1 hour later
1. HOW MANY CYCLE WILL TAKE FOR PRAGRANCY FOR THIS TYPE OF CASE. HMG IS SUITABLE FOR HOW MANY CYCLE.
2. MY DOCTOR NEVER TAKE TEST OF "postovulatory normal progesterone levels, normal endocrine function". ACTUALY HE DONT HAVE SO TIME. HE IS VERY MUCH PROFESSIONAL TO MAKE MONEY. I DONT HAVE OPTION EXCEPT HIM IN MY NEAREST. FOR ONE PATIENT HE SPENT ONLY 3-4 MINUTE.
3. SO PLEASE SUGGEST HOW TO MAINTAIN THE ABOVE FUNCTION. THAT TEST IS REQUIRED AND WHEN.
4. THIS IS MY LAST OPTION TO QUESTION U. SO PLEASE SHARE AS MUCH AS POSSIBLE. I WANT TO READ SOME BOOK ABOUT THIS IF POSSIBLE SHARE IN MY MAIL ID" YYYY@YYYY ". or send some link.
5. CAN I TRAVEL BY TRAIN AFTER OVELUTION AND INTERCOURSE. IF NOT WHEN.
6. SHARE SOME LINK FOR THIS HCG AND HMG THARAPY AND DOSES.
7. WHAT IS THE SPACIAL DIET AND EATING SHOULD BE NECESSARY. WHAT SHOULD I AVOIDE.
8. HOW MANY TIME AND WHEN I SHOULD BE INTERCOURSE.
9. CAN I USE 150 IU INJUCTION 2 TIME BY DIVIDING ONE, WHEN DOCTOR TOLD TO TAKE 75IU.
10. AFTER THIS TYPE OF HMG THERAPY WHAT SHOULD BE THE NEXT.
11. PLEASE SHARE SOME LINK AND DATA ABOUT HMG AND HG THARAPY, I WANT TO READ DOCTOR BOOK.
12. PLEASE SHARE UR MAIL ID . IF U WANT 2 HELP ME AND GIVE ME SOME VALUABLE SUGGESTION.
13. THIS IS MY LAST OPTION 2 ASK U THROUGH THIS WEB.
doctor
Answered by Dr. Sree Gouri SR 2 hours later
Brief Answer:
Ultrasound as scheduled

Detailed Answer:
Hi,
1. The number of cycles to achieve success may differ from person to person.
Ovulation induction with clomiphene, HMG etc are usually not advisable for more than six continuous cycles.
2,3. Postovulatory progesterone supplementation with duphaston given by your doctor previously can help in this cycle also. Thyroid profile etc can help in estimating the endocrine function. Your doctor might have done all these previously.
4.http://www.advancedfertility.com/pcos.htm
5. Yes, you can travel by train.
6.https://umm.edu/health/medical/reports/articles/infertility-in-women
7. You can take all healthy and nutritious foods.
8. Intercourse around the time of ovulation, at least on alternative days.
9. You can take 75 IU as advised by your doctor.
10. Ultrasound as scheduled.
11. Hand book of infertility and ultrasound by Dr.C.B.Nagori.
12,13. Please ask through this website.
Take care.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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