Hi

Infertility is difficulty conceiving after 1 yr of unprotected intercourse and it occurs in 1 in 10 couples , so it is a common problem.
Reproduction requires (1) release of a normal egg (the siphene is suppose to assist here), (2) the production of adequate sperm by the male (this is why the partner should also have a semen analysis (3) the normal transport to the end of the fallopian tube where fertilisation occurs (this is the reason the patency of the fallopian tube must be assessed to make sure that the egg and sperm can trave through it) (4) the subsequent transport of the embryo to the lining of the uterus for implantation and development ( the duphaston will help in preparation of the uterus for the embryo).

Infertility can be caused by male or female factors, male and female factors each account for 35% of cases, often there is more than one cause with male and female factors combined causing 20%, in the other 10% the cause is not known.

In you , the female , if there are issues it could related to the cervix, uterus, ovaries, tubes, peritoneal factors (the uterus, ovaries, tubes occupy a space called the peritoneal cavity).
In your partner it could be related to the deficiency in sex hormones, related to the testes or transport of sperm from the testes (sometimes there is problem with transport).

To determine the exact cause your doctor will evaluate both you and your partner.
Your evaluation should include checking the cervix,uterus, endometrium (lining of the uterus), tubes, checking for ovarian factors, peritoneal factors.
Tests would include a pelvic examination, HSG ( a test which looks at the endometrial space, the cervix, the tubes and can detect any problems), ultrasound, laproscopy (a small tube is inserted to check ).
Semen analysis is required for your partner.

Treatment depends on the cause of the infertility. You are on medication to improve ovulation and to help to prepare the uterus for accepting a fetus.
If the problem is thought to be due to cervial factors then artificial insemination of the sperm into the uterus is done.

If it is due to issues related to the uterus- it depends on the exact nature of the problem, if the uterus is malformed and it affects fertility then surgical correction can be attempted. If polyps are present these can be removed.

If it is due to tubal and peritoneal factors- tubal reconstruction can be attempted, laproscopy can be used to correct other problems seen

If it is related to ovarian problems as indicated by the use of siphene-
Siphene requires that you have adequate levels of estrogen or you will not respond to it. Response to the medication is normally monitored by the use of an ultrasound on day 12 to check for follicle size.You can monitior your urine for LH surge that should occur, you should start at day 12. Ovulation occurs within 32 to 40 hours after the color change.
If using the siphene correctly is unsuccessful then other therapies can be used such as injectable hormones eg HCG or HMG or GnRH.
Any problem that may contributing to the difficulty ovulating must be corrected, these include high prolactin (hormone released in the brain), cushings, thyroid problems.

Any male factors can also be treated.

If the use of these therpies is unsucessful then you can consider invitro ferilization which is the removal of the egg and fertilising it with the sperm in the lab, then placing the embryo into the uterus.

I hope this helps, feel free to ask any other questions

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