Brief Answer:
You need some intervention, after proper reviewing the images & reports

Detailed Answer:
Dear XXXX,

Yes, I do agree that at the age of 31 years, you should not wait for natural conception after trying naturally for more than 1 year; in fact I would have started investigating after six months' trial.

You are a diagnosed case of Hypothyroidism; hence you are on Thyronorm 50 micrograms (not mg) daily. Hypothyroidism can cause problems in conception and pregnancy. In fact I would advise you to get your Thyroid function set to normal before you go for conception, lest the risk of bad events during pregnancy. I would like to know your T3, T4 & TSH levels - both before Thyronorm was started and the current values. Please upload your reports.

Your cycle is varying from 28 - 36 days. May I consider it as an average of 32 days? In that case it is fairly normal. Please keep in mind that the egg release (ovulation) takes place 14 days prior to the next expected menses. You may plan your sexual relations accordingly. In fact it would be quite useful to monitor the ovulation to plan the days of intercourse since you cannot predict the date of your expected menses due to variation of about a week. There are home strips available for ovulation monitoring, as well as you may opt for ultrasonography ovulation monitoring, the later can give you direct visual evidence of ovulation. Also when you are monitoring ovulation by ultrasonography, you know what was the size of the follicle when it ruptured. It does play some role.

I would appreciate if you upload all your reports of hormonal profile instead of just mentioning that they are normal.

And now the issue of the space occupying lesion (SOL) in the endocervical region with Nabothian follicle, which I feel is very critical for your conception. Nabothian follicle is usually due to the infection in the cervical glands. Infection will change the milliu internii of the cervix which can prove to be harmful for the sperms. It needs treatment - may be cauterization of cervix with antibiotics. Further more I am quite concerned about the subtle filling defect in the mid body region in HSG. I want to ascertain whether it is also a SOL or Aschermann's syndrome. Please upload all the images with the reports for my review. After viewing them, I will explain you certain terms I have used.

If the polyp is responsible for the non-conception, it has got to be removed, may be by cauterization of the pedicle or surgically.

I feel I have provided you detailed information and some advice based on the information provided by you. I would like to have more information and reports with the images to help you further more. I am always available for you for any more queries you have, XXXX.

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Brief Answer:
First step should be to get cervical pathologies treated.

Detailed Answer:
Dear XXXX,

To start with, let me give you encouraging news that your Hypothyroid condition now seems to be well in control. 50 micrograms dose of Thyronorm has suited you well and you need to continue on this dose. It is advisable to repeat the test every 3 months and adjust the dose of Thyronorm based on the TSH levels.

Also your tubes are patent and normal.

Your Prolactin levels are within normal limits. Though FSH & LH seem to be within normal range, I cannot say it definitely since the date of your last menstrual period is not mentioned on the reports. Levels of these hormones change every day depending upon the day of menstrual cycle. I would appreciate if you inform me the date of last menstrual period (in relation to the tests performed).

It seems, your ovulation assessment is yet to be performed (apart from FSH/LH levels). Also what about the semen examination of your husband? Conception is an event in which both the partners' contribution is equally important. Will you please update me with the semen report?

Otherwise, my preliminary impression is that the main problem seems to be in your cervix. Please get the polyp tackled successfully from the Gynaecologist. In this procedure, the Nabothian follicle will be taken care of.

I am indeed concerned about your ovulation status. You can once submit yourself for ultrasonography for ovulation monitoring. Please get the event of ovulation dated.

Please clarify my doubts, get the remaining investigations done and upload the reports for my review. Meanwhile, get your cervical polyp treated.

Please do not ignore the advice of regular ovulation monitoring by ovulation monitoring kits or scanning. Plan your physical relations to utilize day of ovulation. For your information, the egg has life of 24 hours and the sperms are active for 72 hours.

I hope this will encourage you to start at some point and go by scientific direction.

If you find the information useful, you may post a good review with 5 starts. However, please do not be complacent on this advice. I want to advise you some more guidelines after you update me with the required information and reports.

For any other information, you may ask any query, XXXX; I am at your service.

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Brief Answer:
Could not find the semen report. Please upload it

Detailed Answer:
Dear XXXX,

I agree with your husband. The only abnormal findings in your case is the cervical polyp & Nabothian follicle. As I have already informed you, Nabothian follicle is formed by clogging of the glands of cervix due to the infection. This chronic infection can cause harm to the sperms and hence needs to be treated. The polyp may cause physical barrier to the sperms in addition to changing the environment. You cannot guarantee the pregnancy by any treatment, however, it could be assured. Since there is a definite finding, get it treated.

Neither the polyp nor the Nabothian follicles can be treated by medicines, however, the procedure required for these conditions is a very minor procedure and depending up on the size of the polyp, could be removed without anaesthesia. If you do not remove it, it may increase in size leading to excessive bleeding. The chances of reoccurrence of the polyp can be depicted only after subjecting the polyp for hystopathological examination.

It seems you have forgotten to upload the semen report of your husband. Will you please do it? Please let me know the file number of this report to make it easy to locate amongst the battery of the reports.

I feel, I have answered all your queries. Now I am awaiting the semen report. Meanwhile, if you want any more information, I am available for you, XXXX.

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