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Suggest Treatment For PCOS And Bulky Uterus
Question: Dear doctor,
I have completed three and half years of my marriage, Initially for two years we did not wanted a child but from fro last last nine months we are trying for baby but we did not received an sucess, Intially first three months we tried on our own and then after three months we visited the Infertility doctor (July 2014) the doctor first asked me period cycle which was 34 days and i used to regularly get period within 34 days.she gave duphaston for 10days which l have to take 1/2 in morning & 1/2 in evening and she recommended to try us during the ovulation period and the days were given by her.
the same thing was continued till sep 2014 but during this period my period cycle was 28 days after taking duphaston. after three months of trying with Duphaston she did by dnc in Nov 14 to find out the uterus problem but the reports were normal. but after sep 14 when i did not took duphaston my period got late by 10 days.she also did a HSG test in DEC 2014 which was also normal. and then again she gave duphaston to regularize my period as from last two my period got very late. now this month after taking duphaston if not got period two days over due.
my husbands semen test is also normal.
In the sonography of ovaries i got PCOS and bulky ovaries.
is PCOS normal..
NOW after HSG test my doctor told me that reports are normal and as per her their is problem in ovulation but she said that we ill start with ovulation medicine after my next period
I have given you my all the case details..
Please let me knw that is my doctor gng in correct way ..
me and my husband are quiet confused with this.
please advice..
I have completed three and half years of my marriage, Initially for two years we did not wanted a child but from fro last last nine months we are trying for baby but we did not received an sucess, Intially first three months we tried on our own and then after three months we visited the Infertility doctor (July 2014) the doctor first asked me period cycle which was 34 days and i used to regularly get period within 34 days.she gave duphaston for 10days which l have to take 1/2 in morning & 1/2 in evening and she recommended to try us during the ovulation period and the days were given by her.
the same thing was continued till sep 2014 but during this period my period cycle was 28 days after taking duphaston. after three months of trying with Duphaston she did by dnc in Nov 14 to find out the uterus problem but the reports were normal. but after sep 14 when i did not took duphaston my period got late by 10 days.she also did a HSG test in DEC 2014 which was also normal. and then again she gave duphaston to regularize my period as from last two my period got very late. now this month after taking duphaston if not got period two days over due.
my husbands semen test is also normal.
In the sonography of ovaries i got PCOS and bulky ovaries.
is PCOS normal..
NOW after HSG test my doctor told me that reports are normal and as per her their is problem in ovulation but she said that we ill start with ovulation medicine after my next period
I have given you my all the case details..
Please let me knw that is my doctor gng in correct way ..
me and my husband are quiet confused with this.
please advice..
Brief Answer:
she is right more or less, but you should go for IUI
Detailed Answer:
Hello,
Thanks for contacting healthcaremagic.
If you both have already undergone 3 cycles of timed intercourse from july to september 2014, then ideally speaking , after getting all your tests done including hormonal profile, HSG and ultrasound pelvis , which showed PCOS as a result, you should have been placed on a diet to reduce weight and started on TAB METFORMIN to reduce insulin resistance which hinders ovulation from october onwards.
A D& C was unnecessary in nulligravidas and can promote undue increased chances of asherman syndrome or adhesions inside the uterus.So it was unnecessary.
You should have been started on follicular monitoring earlier itself from september to understand the follicular growth pattern and if there would have been no ovulation , then ovulation induction drugs could have been started earlier itself.
ANyways , if she has decided to use ovulation drugs in next period it is the right approach but you have to undergo regular follicular monitoring every alternate day by a transvaginal ultrasound to look for growth of follicle and its subsequent rupture or ovulation.
The following protocol should be followed.:-
1. During day2 - day 6 75 mg of clomiphene citrate may be given daily and then follicular monitoring done on day 7,9,11,13 to look for the size of the follicle.
2. if the follicle size reaches 22-24 mmm , then it is assumed that it would ovulate in next few days, hence INJ HCG 10000 units is given intramuscular that night to initiate ovulation.
3. Then ideally after 36 hrs , either timed intercourse is advised or IUI ( INTRAUTERINE INSEMINATION ) of sperms is done to fertilize the egg directly. IUI success rates are higher and you should discuss it with your doctor to perform IUI this time as you already failed 3 previous timed intercourses to save precious time.
In IUI, prewashed samples of husband sperms are directly deposited into the uterus for better fertilization chances and overcoming cervical factors which can cause infertility.
After iui, if the period are missed , then you may test for pregnancy by the rine pregnancy test . If positive good , if negative then you have to undergo the cycle again.
regards
she is right more or less, but you should go for IUI
Detailed Answer:
Hello,
Thanks for contacting healthcaremagic.
If you both have already undergone 3 cycles of timed intercourse from july to september 2014, then ideally speaking , after getting all your tests done including hormonal profile, HSG and ultrasound pelvis , which showed PCOS as a result, you should have been placed on a diet to reduce weight and started on TAB METFORMIN to reduce insulin resistance which hinders ovulation from october onwards.
A D& C was unnecessary in nulligravidas and can promote undue increased chances of asherman syndrome or adhesions inside the uterus.So it was unnecessary.
You should have been started on follicular monitoring earlier itself from september to understand the follicular growth pattern and if there would have been no ovulation , then ovulation induction drugs could have been started earlier itself.
ANyways , if she has decided to use ovulation drugs in next period it is the right approach but you have to undergo regular follicular monitoring every alternate day by a transvaginal ultrasound to look for growth of follicle and its subsequent rupture or ovulation.
The following protocol should be followed.:-
1. During day2 - day 6 75 mg of clomiphene citrate may be given daily and then follicular monitoring done on day 7,9,11,13 to look for the size of the follicle.
2. if the follicle size reaches 22-24 mmm , then it is assumed that it would ovulate in next few days, hence INJ HCG 10000 units is given intramuscular that night to initiate ovulation.
3. Then ideally after 36 hrs , either timed intercourse is advised or IUI ( INTRAUTERINE INSEMINATION ) of sperms is done to fertilize the egg directly. IUI success rates are higher and you should discuss it with your doctor to perform IUI this time as you already failed 3 previous timed intercourses to save precious time.
In IUI, prewashed samples of husband sperms are directly deposited into the uterus for better fertilization chances and overcoming cervical factors which can cause infertility.
After iui, if the period are missed , then you may test for pregnancy by the rine pregnancy test . If positive good , if negative then you have to undergo the cycle again.
regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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