Hallow Dear, At the age past 40, the fertility does go down; however, with proper monitoring and scientific approach, pregnancy is not impossible. Now let us start from the end of your query. Though a couple of parameters in your husband s semen report are somewhat substandard, they do not rule out the possibility of conception. You may have to go for some assisted reproductory technology like intrauterine insemination of so. I am more concerned about your ovarian reserve. On what basis you have been declared a case of premature ovarian failure; and if so how is it that are responding to clomiphene citrate by ovulation? Anyway, your ovarian reserve seems to be very poor. Hence I would advise you to monitor ovulation by ultrasonography. This will help assessing the endometrial growth also. Ovulation from the follicle between 18 mm to 21 mm gives best results. The endometrial thickness between 9mm to 14 mm at the time of ovulation (thus indirectly conception and implantation) is very conducive for successful implantation and pregnancy. So at the time of ovulation with such conditions, you may get intrauterine insemination done to increase the possibility of pregnancy. You may try this for 3 months (considering your age and ovarian condition) after which you might seriously think of in vitro fertilization and embryo transfer. In this advice, I am presuming that you have tested the patency of your tubes and they are patent. If you have not tested, please get Hysterosalpingography and/or Laparoscopy done for the tubal assessment before you take any active intervention step. I hope this clarifies your doubts. Dr. Nishikant Shrotri