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Suggest Treatment For Infertility

Posted on Wed, 26 Mar 2014

Question: hello doctor, im 28 yrs old. planning to conceive. i have mild pco. All my blood reports are gud normal except MULLERIAN AMH serum 10.2 (high) last month follicular study has been done and below are the details; day 9 - right ovary 20.1x17.5 and left -small follicles . endotrium 3.8 day 11-R.O -26x23.6 and left -15.3 x13.3 endotrium 4.3 day 13 -30.5x27.2 and left 21.6x19.3 endotrium 4.9mm day 15-35.7x35.6 and left 27.9x21.3 endotrium 5.5mm doctor told me the day 9 was gud for giving injections but i did not vist her as i wasnt aware. on day 11 she confirmed not good for injection as follicular size is more and endotrium too. she asked me to forget and plan next month. to get my period on time she asked me to take endogest 200 for 10 days. today i got my period. Im very desperate to have my first kid. my periods were regular till last yr august 2013. Please help me if need info let me know. thank u

Answered by Dr. Bhagyashree.B (27 minutes later)

Brief Answer: ovarian response good. chance of success better. Detailed Answer: Dear XXXXXXX Thanks for writing to healthcare magic. You have mentioned PCOS. Was the ultrasound report after ovulation stimulation medicine like clomiphene? The ovarian response is good. The follicles are also of good size and growth was good. The endometrial thickness is a cause for concern as it should be triple layer appearance and measure atleast 8mm on the day of injection of HCG. If your husband's semen analysis is normal then there is no need to worry as chance of success is >80%. Drug like tab alivher will improve endometrial thickness. Next cycle you can consider tab clomiphene and ultrasound on alternate days from day 9. When follicle size is right HCG injection should be taken and intercourse on day of injection. Please keep faith. I hope your blood tests including thyroid are normal. Thanks. Dr Bhagyashree

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Bhagyashree.B (22 hours later)

yes medicine included clomiphene. and my huband semen test analysis say active motile 60 %. thyroid is normal. I visited my doctor today as its my second day of period she asked me to get scan to check if the cyst in my right ovary has disappeared. and my pelvic scan says; anteverted uterus 6.3x4.3x2.6cm. right ovary 3.3x2cm and left 3.7x1.8. no fluid found in pod. no mass lesion. imprsssion anteverted uterus with 3.6 endometrial complex and bilateral polycystic ovaries. so my doctor asked me to forget abt child now for three months as the ovarian stumilating tablets are working other way and resulting in polycyctic ovaries and said i can conceive normally after three months. prescribed me bigomet 500mg twice a day apcod poweder twice 10 am and 6 pm and OVRAL G from 2nd day on my period for 20 days . this is prescribed for next three months. is this valid and im not sure how this works so there is no possiblity of pregency for three months. and tablet ovaral g is used for ? i need details . im on right path. help me i turning mad or should i go to another doctor.

Answered by Dr. Bhagyashree.B (1 hour later)

Brief Answer: treatment is right Detailed Answer: Dear XXXXXXX I can understand why you are confused. Most patients with infertility need detailed counselling about the process of fertilization and pregnancy. The cyst in ovaries are actually unruptured follicles from previous cycle. As long as there are cysts the clomiphene will not work. Usually detailed hormone analysis shows change in FSH and LH hormones. The correct method is to do. Fasting hormone analysis on second day of period for FSH, LH, prolactin, TSH. The treatment is on right track. I would prescribe following to my patients in Clinic 1. Bigomet 500 mg twice a day 2. Folic acid 5mg once a day 3.Tab Diane 35 Diane 35 works better than ovral g. After 3 cycles write back with hormone reports and ultrasound report. The cysts should reduce and hormone should be normal before clomiphene. consult with your doctor regarding switching to Diane 35. Thanks Dr Bhagyashree

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Bhagyashree.B (1 hour later)

Hi XXXXXXX thanks for your detail reply. i thank this website and finding right doctor you. Now i feel a bit relaxed knowing im given correct treatment . And as u and my doctor confirmed i can conceive . my doctor also said i can conceive naturally after three months. i feel better. And let me brief you abt my blood reports; these are taken in aug 2013. haemoglobin:13.6, rbc:4.8 ,wbc:7.2 neutrophils -58 lymphocytes-38 monocystes:2 esinophil:2basophils 0 platelet count:adequate Glucose random:96mg/dL TSH: 1.55 (range 0.32-5.50) T4:9.30 t3:1.11 prolactin:23.12 MULLERIAN AMH serum 10.2 estrogen 25 pg/ml testosterone:40.08ng/dL Follicle stimulating hormone 4.03miu/ml LH 2.93 miu/ml DHEA-s 285 ug/dL insulin fasting: 5.00 mu/L lookg at my reports above ,if there is no harm using diane 35, i shal use it as my doctor gets angry if i suggest her something. u seem great. wish i can talk to you. well if u can my number is 0000, i may seem crazy but im really confused. but to large extent feel better now. thank you .

Answered by Dr. Bhagyashree.B (9 minutes later)

Brief Answer: report are ok Detailed Answer: Dear XXXXXXX Your reports are ok. Your FSH and LH levels are in right range. If day 2 LH is less than 3 then PCOS is of mild range. Besides other reports are normal. If you wish to talk then you can ask website for a call consult next time. Thanks Dr Bhagyashree.

Above answer was peer-reviewed by : Dr. Yogesh D