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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Is The Cause And Treatment For Infertility?

I have PCOD ever since I started menstruating at the age of 14 or so. However, I am not obese, in fact, quite fit, exercise often. I usually miss my periods every alternate month. I am 30 yrs now. Was on birth control pills for three months. In May this year, I underwent Ovulation Induction with Clomiphene tablet of 50 mg. On day 13th , my dominant follicle (total 5 in both ovaries) had matured to 24.5 mm. the endomitrium lining was 8.6 mm. That's when I took the HCG injection of 5000. I think my folllicles ruptured between day 15th and 16th. On all these days, I had intercourse with my husband. Unfortunately, my periods started and I did not conceive. What possibly could be the reason?
After my periods started subsequent to a negative pregnancy result, I visited the doctor on day 2 again as I couldn't wait to find my answers and retry. The doctor advised me to do TVHSS-Hysterososal...graphy (to see if my tubes are blocked). I did this test on day 8th of my cycle. It was not blocked. Also, my follicle had grown till 13 mm. Do you think it is a good sign that my follicle will mature enough for ovulation to take place this time without stimulation? Since I am a PCOD patient, I am not sure about that. After that I have not done any monitoring though my doctor had asked me to. My doctor suggested to try the natural way this cycle without stimulation. Today is day 12th. It is a sunday and therefore, all clinics are also closed. My questions are: If I do my monitoring tomorrow on day 13th, what is the size of follicle that is ideal for day 13th in my case where I have not undergone any stimulation? If it is a good size, would you recommend taking an HCG injection in my case? If so, when is the best day to do so - tomorrow itself or wait for another monitoring on day 14th? My doctor was also earlier suggesting that I undergo IUI in order to increase my chances of conception. Her plan was to give me clomid for next cycle, then do the whole process follwed by IUI. However, I am hoping that if the follicles mature well, and if there is a possibility to release my egg (if necessary, even with HCG injection), then I am keen to get an IUI in this cycle itself to increase my chances. Is this possible? Is it possible to get an IUI in a natural cycle with one follicle without stimulation?
I also have another question - does taking medications and assistance for increasing chances of pregnancy, such as clomid, HCG, and IUI and so on have any side effects. For instance, I am concerned about the TVS tests. I feel that during the process of follicular monitoring, the gel that is used to scan may have adverse effect on the sperm motility. Can you pleasse provide answers to some if not all of my questions. I will be very grateful to you for the same. Also, if you can do it asap since i am already on day 12th and want to have a baby asap... since i have been trying for too long. last month was a very depressing month for me waiting to take the preg test and then gettign a negative.
Wed, 24 Sep 2014
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OBGYN 's  Response
Hi, thanks for writing..
i understand your concern..
This is a case of unexplained infertility.. Dont take tension.. In my opinion this cycle you can try naturally. Tomorrow your follicle size might be around 18mm. repeat follicular study might be required on day 15 and when the follicle size reaches 20mm, hcg can be taken if you are too anxious.. IUI is done after 36 hrs of injection. Mostly it is done in a stimulated cycle as the chance of pregnancy increases with the no of follicles..TVS gel has no side effect of sperm motility. Repeated use of clomiphene has many side effects about which you neednot worry too much now.. Eat healthy and take adequate rest. In the post ovulatory period take progesterone for 10 days for luteal phase support. Hope I have answered your query. Good day.
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What Is The Cause And Treatment For Infertility?

Hi, thanks for writing.. i understand your concern.. This is a case of unexplained infertility.. Dont take tension.. In my opinion this cycle you can try naturally. Tomorrow your follicle size might be around 18mm. repeat follicular study might be required on day 15 and when the follicle size reaches 20mm, hcg can be taken if you are too anxious.. IUI is done after 36 hrs of injection. Mostly it is done in a stimulated cycle as the chance of pregnancy increases with the no of follicles..TVS gel has no side effect of sperm motility. Repeated use of clomiphene has many side effects about which you neednot worry too much now.. Eat healthy and take adequate rest. In the post ovulatory period take progesterone for 10 days for luteal phase support. Hope I have answered your query. Good day.