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Unable to conceive, heavy periods, wants to take clomid, multiple fibroids in sonogram, MRI normal. Treatment ?

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Infertility Specialist
Practicing since : 1982
Answered : 22 Questions
I am 45 and am having trouble getting pregnant. I have two other children, but have not been able to get pregnant since my last child was born 14 years ago (no contraception used at all during this time). I was told by an ER doctor, when I went to the ER for abnormally heavy bleeding during a menstruation, that the sonogram that they performed showed multiple uterine fibroids. I went to a specialist in uterine fibroids and had a MRI done (with and without contrast). No uterine fibroids were found, and the doctor's analysis was that there was no physical reason for why I can't conceive. I am ovulating most months (6 out of 8 months that I charted my cycle), and while she is not a fertility specialist, she said that my luteal phase may be too short to get pregnant and recommended I speak to my ob/gyn about putting me on clomid. My ob/gyn said that he would not recommend clomid and that I was fine. He has never done any fertility tests on me, so I don't know how he came to this decision. I'm confused and need another opinion.
Posted Fri, 13 Apr 2012 in Infertility Problem
Answered by Dr. Aniruddha Malpani 13 hours later
Thanks for the query.

I am concerned about your advanced age.This suggests you may have poor ovarian reserve .

Usually, ovarian functions goes hand in hand with age, and as a women becomes older, her ovarian response starts declining. Every girl is born with a finite number of eggs, and their number progressively declines with age. A measure of the remaining number of eggs in the ovary is called the "ovarian reserve"; and as the woman ages, her ovarian reserve gets depleted

Your next step is to do a clomid challenge test to assess your ovarian function ( reserve ) because you may have reached the oopause.

This is the way to do the test.

Day 1 = day the bleeding of the period starts

On Day 3 , you need to do a blood test to measure your levels of FSH,LH,PRL and TSH; and AMH ( anti-mullerian hormone)
Do this from a reliable lab please - for example, SRL (

Take 100 mg clomiphene citrate from Day 5 - Day 9.

Repeat the blood test for FSH again on Day 10 ; and then email me the reports.

If the Day 3 plus Day 10 FSH levels are less than 25, then we can try to do IVF with your own eggs.

If the Day 3 plus Day 10 FSH levels are more than 25, this suggests you have ovarian failure,
and that donor egg IVF would be your best treatment option, if you are willing to consider this.

A low AMH level will help to confirm this diagnosis.

You can also test your antral follicle count by doing a vaginal ultrasound scan ?

The most useful test is called an antral follicle count ( AFC) , in which the doctor counts the number of antral follicles ( also referred to as resting follicles) present in the ovary on Day 3 using vaginal ultrasound scanning. Antral follicles are small follicles , usually about 2-8 mm in diameter. The number of antral follicles correlates well with ovarian response. A normal total antral count is between 15 and 30. If the count is less than 6, the prognosis is poor.

Time is now at a premium for you - please don't waste it ! You should never have any regrets that you left any stone unturned and didn't give yourself the best shot at fertility treatment. Treatment can be expensive, but a baby is priceless !

Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

We look forward to helping you to have a baby !

Hope i have answered your query.I will be available for follow up.

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