Hello and Welcome to ‘Ask A Doctor’ service.
I have reviewed your query and here is my advice.
You seem to develop follicles but they do not rupture due to
PCOS.
HCG can be used to help in rupturing follicles. Usually it is given at follicle size 16 mm and above. If it is reaching this size in more than 16 days, try a higher dose of
clomid, or combine it with letroz or
sildenafil, depending upon the condition of endometrium.
Metformin can also be used for PCOS after discussing with your
infertility specialist. There is no clear limit on when follicle should mature. Also the ovulation study was done on day 14 and then 19. A gap of 4 days at peak follicle size is not advisable and it needs to be done more frequently to detect a 14-16 mm follicle.
Try this for 1 or 2 cycles only, preferably with IUI for best results. Repeated use of clomid makes the endometrium weak and it cannot receive a fertilized ovum hampering
pregnancy even if there is ovulation.
If there is no response then laparoscopic drilling offers best solutions and maximum chances of conception in the next few cycles post drilling.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Madhuri N Bagde