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What do my lab test results indicate?

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Posted on Thu, 19 May 2016
Question: Dear Dr.,

We are married for three years and trying to conceive. Im aged 29yrs, 5'6",80kg and wife is 28yrs, 5'2",76kg. Semen analysis report done with 68mn/ml with actively motile 40%. Wifes monthly cycle is normal lasting 27 to 28days.

We consulted a Gynaecologist and took following medicine as prescribed.

From 27 February 2016, 5th day of my wifes cycle.

SMARTOVA 100 - for 5 days (1-1-1)
(Clomifene Citrate with Ubidecarenone Soft Gelatin Capsules and N-Acetyl Cysteine Tablets)

Met-PC Care for 30 days (0-1-0)
(Myo-Inositol BP 550mg,D-Chiro-Inositol 13.8mg,Metformin Hydrochloride IP 500mg,L-Methylfolate Calcium 0.50mg,Mecobalamin 750mcg)

FoPyMin act for 30days (1-0-0)
(L-Methylfolate Calcium USP 1mg, Pyridoxine-5-Phosphate 5mg and Mecobalamin JP 1500 mcg)

Folicular Study was conducted on 05th March 2016, details as follows.

LMP-24.02.2016

Uterus - Size 69x24x41 mm, Normal in shape, size and echo texture.

Endometrium- Appears normal. Endometrial thickness is 5.2mm. Endometrial Cavity empty.

Both ovaries- Appears normal in size, shape, and folicular structure. RO-25×22mm, LO-32×26mm

Dominant folicles on 05 March 2016 study
Day of cycle 11th
RO- 19×14mm, 13x10mm
LO- 14×16mm, 15x14mm, 12×12mm
Endometrial thickness-5.2mm
POD-Minimal free fluid

Dominant folicles on 08 March 2016 study
Day of cycle 14th
RO- 26x22mm, 18x15mm
LO- 24x17mm, 25x24mm, 17x18mm, 19x15mm
Endometrial thickness-6.4mm
POD-Minimal free fluid

Dominant folicles on 12 March 2016 study
Day of cycle 18th
RO- 30x28mm, 28x22mm
LO- 31x29mm, 29x28mm, 29x24mm, 24x20mm
Endometrial thickness-7.4mm
POD-Minimal free fluid


The query is, no rupture of folicles is happening and size of folicles are increasing. My wife is having subtle pain on ovaries. Please advise
doctor
Answered by Dr. Mahesh Koregol (30 minutes later)
Brief Answer:
Take trigger injection

Detailed Answer:
Hi,

I understand your concerns.

Your wife is not ovulating. She needs to take Inj.hCG 5000 IU injection to help in ovulation. This injection will help in ovulation and egg release.

Let me know if you need anymore help.

Regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mahesh Koregol (20 hours later)
Dear Dr. XXXXXXX

Thank you for your consideration and valued review.

We have raised the matter on injection to the Gaencologist. In her opinion injection is not preferred when there are multiple dominant follicles.

Please consider our grave concern in the matter. Is it normal for women under such medication to have multiple follicle having the size more than the ovary itself. I can feel the bulge near to her pubic region, i think follicles are still growing in size. Its day 19th of the cycle.
doctor
Answered by Dr. Mahesh Koregol (7 hours later)
Brief Answer:
Injection can be taken

Detailed Answer:
Hi,

Your doctor seem to be worried about ovarian Hyperstimulation Syndrome (OHSS) where in complications are feared if follicles are more.

In my opinion you can take injection for triggers OHSS chance is not high.

Follicle size can be bigger than ovary if turned into cyst which is no longer a useful follicle.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Mahesh Koregol

Infertility Specialist

Practicing since :2000

Answered : 3806 Questions

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What do my lab test results indicate?

Brief Answer: Take trigger injection Detailed Answer: Hi, I understand your concerns. Your wife is not ovulating. She needs to take Inj.hCG 5000 IU injection to help in ovulation. This injection will help in ovulation and egg release. Let me know if you need anymore help. Regards