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    Suggest treatment for irregular menstrual cycle

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Posted on Wed, 12 Aug 2015 in Infertility Problem
Question: How on earth can I get pregnant with a cycle like this:
JANUARY 2015
23rd January - 27th January (5 days bleeding)
Cycle 24th December – 22nd January = 30 days

FEBRUARY 2015
NO PERIOD

March 2015
4th March – 8th March (5 days bleeding)
Cycle 23rd January – 3rd March = 41 days

April 2015
9th April – 13th April (5 days bleeding)
Cycle 4th March – 8th April = 31 days

MAY 2015
8th May – 12th May (5 days bleeding)
Cycle 9th April – 7th May = 29 days

Started Acupuncture

XXXXXXX 2015
3rd XXXXXXX – 8th XXXXXXX (6 days bleeding) 2nd XXXXXXX spotty pink, cycle day 1,2 only pink when wipe, cycle day 3,4 red bleeding but only requiring 1 towel, cycle day 5,6 pink/brown discharge
Cycle 8th May – 2nd XXXXXXX = 26 days

16th XXXXXXX – 21st XXXXXXX (6 days bleeding)
Cycle 3rd XXXXXXX – 15th XXXXXXX = 13 days

JULY 2015
1ST July – 5th July (5 days bleeding)
Cycle 16th XXXXXXX – 30th XXXXXXX = 15 days

Finished Acupuncture


JULY 2015
22nd – ( days bleeding)
Cycle 1st July – 21st July = 21 days

I am seeing a Fertility Specialist who has run all kinds of tests and there is nothing wrong. No PCOS, no nothing

Blood results are as follows: Estrogen 115, LH 1.7, FSH 5.6 (taken on Day 2 of cycle)

Ultrasound scan shows multiple follicles and endometrial thickness of 8.4mm.

Husband semen analysis also normal

doctor
Answered by Dr. Nishikant Shrotri 2 hours later
Brief Answer:
Menstrual irregularity needs to be addressed

Detailed Answer:
Dear XXXXXXX

I have gone through your nicely narrated menstrual history. I will get back to your question about pregnancy after brief narration and some questions.

This history clearly suggests that there is irregularity in your menstruation. You have missed your periods in between. In February 2015 you had missed your period. In XXXXXXX and July 2015, the periods are not regular with proper bleeding.

I would like to have your serum FSH & LH levels repeated around 14th day.

Have you monitored the ovulation by ultrasonography? What are the reports?

Please get examined internally from a gynaecologist to find out whether you have any vaginal discharge and/or infection which can damage the sperms. Also I would request you to get your Post Coital Semen Examination. In this test, the semen is collected from the vagina after the intercourse for laboratory examination. This test reveals whether the sperms are getting damaged in your body.

Please try to understand that at the age of 39, the quality of eggs is not of a high level. However, the women can conceive even at this age.

Please upload all your and your husband's previous reports and the reports of newly suggested investigations by me. After viewing the reports, I would be able to guide you further after viewing the reports.

Monitoring egg release by ultrasonography and planning the intercourse accordingly is a very good way to success when all other investigations are normal.

I have given you few suggestions based on the information you have provided me. With more information as requested by me, I can opine further more.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Nishikant Shrotri 17 minutes later
Sorry this is all the results I have. I have had internals and everything is normal x

It is only since acupuncture I have had a problem so I have stopped it.
doctor
Answered by Dr. Nishikant Shrotri 15 minutes later
Brief Answer:
Some more information is required, please.

Detailed Answer:
Dear XXXXXXX

If this is the only you have, it does not give me all the information I want.

Will you please elaborate or upload the images and results of your Post Coital Semen Examination and Ultrasonohraphic Ovulation Monitoring at least in order to give me some idea about sperm antibodies and ovulation?

I have also realized that when you were on acupuncture, your menses were disturbed. Let us hope that they become regular gain after you have discontinued acupuncture.

Dear XXXXXXX I do want to express my opinion on your problem, however, some more information is required. Will you please furnish me the requested information?
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Nishikant Shrotri 21 minutes later
I do not have info you request xx
doctor
Answered by Dr. Nishikant Shrotri 2 hours later
Brief Answer:
Ovulation monitoring may help you to conceive

Detailed Answer:
Dear XXXXXXX

I understand that you do not have the information readily available with you from all the previous investigations? Is it possible for you to get few new investigations done?

Meanwhile, I am suggesting you following:

Please try to locate the day of your egg formation (ovulation). In good old days, there were number of indirect methods like BBT for this. However, now with the modern gadgets and advance techniques, we have got methods to spot the egg formation directly. Ultrasonography helps us in collecting the evidence.

You will have to submit yourself for Ovulation Monitoring by Ultrasonography from day 9 of your cycle. Everyday, you will be informed about the progress of follicle and endometrial thickness. Usually the follicle ruptures and the egg is released after the follicle crosses its diameter of 18 mm. This is usually 14 days prior to next expected menses. So if you plan your sexual intercourse accordingly, the chances of success are quite high.

If the follicle does not rupture even after it attains diameter of 21 mm, then the chances of healthy egg and pregnancy are low. If it happens repeatedly, then your Gynaecologist may opt to induce the egg release at 18 mm size by giving hCG injection.

I think, with the available information that you have provided, I can suggest you this much.

Please reconsider whether you can get the other investigations I have suggested performed and inform me.

I am awaiting your positive response.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Nishikant Shrotri 2 hours later
I have a clearblue fertility monitor that shows peak days so is that good enough? Should I conceive naturally? I was 17 stone 4 pound I am now 16 stone 8 pound and still trying to lose weight x
doctor
Answered by Dr. Nishikant Shrotri 10 hours later
Brief Answer:
You may try it for few cycles

Detailed Answer:
Dear XXXXXXX

The Clearblue Fertility Monitor is an equipment which helps you to predict the ovulation by hormonal levels. It is an indirect method of anticipating day of ovulation. It is a fairly good and accurate tool. You may make use of it.

However, it does not provide you any information about the size of follicle, the number of follicles, etc. though it can be inferred indirectly by hormonal ranges.

Since you had irregular menses for last few months you will have to wait till your menses are regularised for a couple of months before you start using this fertility monitor.

If this tool does not give you results within few trials, I would urge you to shift to ultrasonographic ovulation monitoring which will reveal even the size of the follicles and prompt for any intervention required.

Good, you have informed me your weight. That seems to be the problem. However, you are working on it. Please understand that it could be PCOS problem. However, you have mentioned that PCOS is ruled out.

And lastly, I would again request you to find about any hostile atmosphere inside your vagina for the sperms. Sometimes, vagina may have antibodies or any other factors which are hostile for sperms. In such cases, if those factors cannot be taken care of, intrauterine insemination or in vitro fertilization may have to be tried.

For any further information I am always available for you XXXXXXX I would appreciate if you provide me more detailed information which I had requested you previously.
Above answer was peer-reviewed by : Dr. Shanthi.E
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Answered by
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Dr. Nishikant Shrotri

OBGYN

Practicing since :1968

Answered : 2916 Questions

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