Question: Hi Doctor, Hope you are good. I asked you a question on 17/10/2013 as follows, Hi, I was diagnosed with PCOD 2 years back when I was not married. With doctor's advice I took birth control pills and thus my menstruation became normal. I got married 18 months ago. I have not conceived yet but my cycles are normal for the last 8 months without any pills. Today I visited the same doctor and she said that I can never be able to become pregnant normally because of the PCOD. According to her some injections and long term monitoring will be required for successful ovulation. My weight is 58 kg, BP is low, age 27. I don't have thyroid problems and my prolactin is normal. On 12th day, my egg size is 7. Kindly suggest the future course of action for me. I have been given APCOD for three months from today. Kindly let me know the use of this medicine. Thanks To this question you replied As you have not conceived yet for 18 months, you should please consult an Infertility Specialist now. Am sure the basic problem in conception is PCOD. In this condition, due to unknown reasons, a widespread hormonal imbalance exists in the body. The ovary gets studded with multiple eggs, none of which mature to form a follicle which ovulates every month. First go for the following workup - AMH FSH and LH on day 2 of cycle DHEAS and free testosterone levels Oral glucose tolerance test TSH and prolactin ( if not within last 6 months, then repeat ) Fasting serum insulin. Next, you might be given treatment like Metformin to control PCOD. You have not mentioned your height, so I cannot calculate your BMI. If overweight, please aim at gradual weight loss as it will help PCOD. APCOD contains Myoinositol , folic acid and vitamin D 3. Its use is supposed to help to control the symptoms of PCOD, however PCOD has no absolute cure as such. Most women with PCOD do conceive successfully, but often require external aid to induce proper ovulation. Normally, ovulation occurs on day 14, and then the egg size should be between 18 - 21 mm, so on day 12, your egg size is not optimum. However, in PCOD, often ovulation is delayed , so the egg might grow to desired size later on. Mostly you would need help of ovulation inducing agents ( can be tablets and can be injections ) and monitoring to help you conceive. Let me tell you the plan of action for you, which I would suggest to a patient of mine - 1. Get the investigations for PCOD done as suggested. 2. get your husband's semen analysis done. 3. Get one cycle of plain follicular monitoring ( ultrasound throughout the menstrual cycle at regular intervals to check if you are ovulating naturally ). 4. If you ARE ovulating by yourself, then try naturally for 3 months, with follicular monitoring continued to allow you to pinpoint probable days of ovulation, around which you should be sexually active. 5. If you are NOT ovulating naturally, try ovulation induction first with clomiphene citrate tablets for 3 - 6 months ( injections of gonadotropins can be added if you do not respond to clomiphene also, most women with PCOD do respond well to clomiphene alone ). You can combine cycles of ovulation induction with IUI ( intra uterine insemination ) to increase pregnancy chances. 6. If this fails, please go for hysteroscopy and laparoscopy to check if your fallopian tubes are open. 7. If tubes are blocked / if multiple cycles of ovulation induction fail to yield pregnancy, you can go for IVF ( in vitro fertilization ). Continue taking APCOD meanwhile. Do not stress out, you are young, and am sure in due time, you will see positive results. All the best. Please feel free to ask for further clarifications. Take care. Subsequently I continued visiting the same Gynaec. On her advice I took APCOD XXXXXXX for 3 months and Doxt S tablets for 6 days and I tested for TSH and Prolactin on Day 3 of my cycle. The reports came out normal. My husband’s semen analysis was also done. It was normal too. My next cycle was on 23.11.2013. I visited the doctor on 25.11.2013. On examination, she remarked that eggs were smaller than required and there were cysts like earlier. I was prescribed ovofer 100 mg for 5 days, emgra 2 mg for 28 days and ovacare for a month along with APCOD continuation. Then I was called on Day 12 for further examination. On Day 12 (4.12.2013), there were no growing follicles according to the Gynaec and the egg size was 7. Then she suggested to continue Emgra and Ovacare and visit her on Day 3 of next cycle. But I missed periods this time on 23.12.2013. On doctor’s advice I used preganews on 30.12.2013 which was negative. With her advice I took deviry 10 mg from 31.12.2013 to 5.1.2014 to get my periods. But as it was not occurring so we visited her on 16.1.2014. After examination she said that my endometrial wall was thick. I was told to take an injection of Proluton depot 250 mg alone or with progynon 10 mg to start my periods. I took the injection on 20.1.2014 but there were no periods till 25.1.2014. So, I visited her on the evening of 25.1.2014. To my surprise she said that I have conceived for 4 weeks. Now I have been given Duphaston 10 mg, Fol 123 and Naturogest 200 mg for a month and a Ultrasound 2 weeks later. Now, my questions are 1. Is this a normal pregnancy? Should I continue with the pregnancy? 2. Will there be any effect of deviry and Proluton injection on the child? 3. As I am allergic so I take asthalin inhaler regularly. Moreover I take sinarest and cetriz too. Are these harmful to the fetus? As I am constantly allergic so is there any alternative to Sinarest/ Cetriz for a pregnant woman? My DOB- 25.10.1986, weight- 58kgs, BP- 120/80 and height- 5 ft 1 inch. Thank you.

Hi Doctor, Thanks a ton for your detailed reply and caring words. Kindly clear my doubts on the following topics also. 1. Are there any precautionary measure I can undertake from now so that my child doesn't get any kind of allergy from my blood? 2. What can be the expected time of delivery? 3. As of now my husband gives me lift in his scooter to and from my office. Is that alright or should I go on leave immediately? If yes, then till when I should be only indoors? Moreover should I avoid any kind of vehicles for the first trimester like rickshaw, auto rickshaw or car? 4. Kindly recommend some nutritional supplements for my upcoming child during my pregnancy. 5. Should I get tested my blood for any particular diseases?

Thank you doctor once again for your insightful and detailed reply. I forgot to mention that I take tab Wysolon for my allergic cough when it gets out of control. Moreover, may I ask you whether lovemaking is safe during pregnancy?