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30 Year Old With Thalassemia Minor, Trying To Conceive. IUI Didnt Work. USG Normal, Regular Ovulation. How Long To Try Naturally ?
Question: Hi ,
I am a 30 year old woman with Thalassemia minor. I have been trying to conceive for 6 months now. I have regular cycles 26 - 28 days with normal flow. My husbands semen analysis is normal with 80 mill sperms/ml. I have gotten my USG done which shows no fibroids and no cysts in the ovary. I met a specialist last month who put me on clomid minimum dose and monitored my ovulation. I had 3-4 follicles and one did burst. I got an IUI done in that
cycle which did not work. I did not continue with a second IUI. I have been monitoring my ovulation with OPKs and am comfortable with them.
My questions are :
1. I got an AMH done which was 1.19 ( normal more than 2). Should i worry about this , since i still have very regular ovulation and i seem to ovulating fine as seen on the USG also ?
2. My Hb stays around 10 g%.. can this affect fertility ? I am on regular folate.
3. How long should i continue to try naturally before i opt for multiple IUIs or IVF ?
4. SHould i get an HSG done ? I have never had any surgery or D&C before.
5. Ever since i have started trying, i have started having more premenstrual cramping which i never had before and one episode of premenstrual spotting which i have never experienced before either. THis gets very frustrating because i keep wondering whether they are early pregnancy symptoms !
Best regards
G
I am a 30 year old woman with Thalassemia minor. I have been trying to conceive for 6 months now. I have regular cycles 26 - 28 days with normal flow. My husbands semen analysis is normal with 80 mill sperms/ml. I have gotten my USG done which shows no fibroids and no cysts in the ovary. I met a specialist last month who put me on clomid minimum dose and monitored my ovulation. I had 3-4 follicles and one did burst. I got an IUI done in that
cycle which did not work. I did not continue with a second IUI. I have been monitoring my ovulation with OPKs and am comfortable with them.
My questions are :
1. I got an AMH done which was 1.19 ( normal more than 2). Should i worry about this , since i still have very regular ovulation and i seem to ovulating fine as seen on the USG also ?
2. My Hb stays around 10 g%.. can this affect fertility ? I am on regular folate.
3. How long should i continue to try naturally before i opt for multiple IUIs or IVF ?
4. SHould i get an HSG done ? I have never had any surgery or D&C before.
5. Ever since i have started trying, i have started having more premenstrual cramping which i never had before and one episode of premenstrual spotting which i have never experienced before either. THis gets very frustrating because i keep wondering whether they are early pregnancy symptoms !
Best regards
G
Hi,
Thanks for your query.
I read your detailed history. The detailed history helped me to understand your problem better.
Based on the information you have provided, following are my advice as per your questions:
1) AMH (Anti Mullerian hormone) gives us information about the "ovarian follicular reserve" meaning the number of eggs left in your ovary which are likely to ovulate throughout your reproductive career. Though you may be regularly ovulating, this predicts how long you are going to continue to ovulate normally and oocytes are going to be of good quality reserve. Hence this report shows that your follicular reserve is reducing and you have to get pregnant soon as your reserves are going down.
2) Your hemoglobin level is fine at 10 gm%. This would not interfere in getting pregnant. Don’t worry about it. Please continue taking folate. It helps when you get pregnant.
3) Since you have tried for 6 months and your AMH is low I would suggest you go ahead with Intra Uterine Insemination (IUI) for 3 to 6 months with follicular growth scan (FGS). If you don’t conceive you should go ahead with IVF.
4) You should get HSG done as it is primary investigation to assess patency of fallopian tubes. Diagnostic Laparoscopy is better for your condition than HSG.
5) The cramping could be due to endometriosis which is causing premenstrual cramping. Getting a diagnostic laparoscopy will help in diagnosing and treating endometriosis as well as fallopian tube patency.
I hope I answered your question. I will be available if you have any more concerns.
Regards,
Dr.Mahesh Koregol
Thanks for your query.
I read your detailed history. The detailed history helped me to understand your problem better.
Based on the information you have provided, following are my advice as per your questions:
1) AMH (Anti Mullerian hormone) gives us information about the "ovarian follicular reserve" meaning the number of eggs left in your ovary which are likely to ovulate throughout your reproductive career. Though you may be regularly ovulating, this predicts how long you are going to continue to ovulate normally and oocytes are going to be of good quality reserve. Hence this report shows that your follicular reserve is reducing and you have to get pregnant soon as your reserves are going down.
2) Your hemoglobin level is fine at 10 gm%. This would not interfere in getting pregnant. Don’t worry about it. Please continue taking folate. It helps when you get pregnant.
3) Since you have tried for 6 months and your AMH is low I would suggest you go ahead with Intra Uterine Insemination (IUI) for 3 to 6 months with follicular growth scan (FGS). If you don’t conceive you should go ahead with IVF.
4) You should get HSG done as it is primary investigation to assess patency of fallopian tubes. Diagnostic Laparoscopy is better for your condition than HSG.
5) The cramping could be due to endometriosis which is causing premenstrual cramping. Getting a diagnostic laparoscopy will help in diagnosing and treating endometriosis as well as fallopian tube patency.
I hope I answered your question. I will be available if you have any more concerns.
Regards,
Dr.Mahesh Koregol
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thankyou for your reply.
As i understand, i am not clinically infertile till i have tried for a year. I had just gone to a specialist to get the basics checked and the low AMH report resulted in the IUI being planned. I am still unsure about whether i want to get into all these invasive procedures right away, or whether i should give myself another 6 - 8 months of naturally trying.
In your assessment would you suggest immediate intervention or should i wait for another 6 - 8 months ?
In the situation in which i continue trying are there are any drugs that can help ? Can i take low dose clomid D5 to D9 ?
Regards
G
As i understand, i am not clinically infertile till i have tried for a year. I had just gone to a specialist to get the basics checked and the low AMH report resulted in the IUI being planned. I am still unsure about whether i want to get into all these invasive procedures right away, or whether i should give myself another 6 - 8 months of naturally trying.
In your assessment would you suggest immediate intervention or should i wait for another 6 - 8 months ?
In the situation in which i continue trying are there are any drugs that can help ? Can i take low dose clomid D5 to D9 ?
Regards
G
Hi,
Thanks for writing back.
By definition you can try for a year before being called infertile. But in your case you have been diagnosed of low AMH levels. When diagnosis is infront of us I dont see any need to wait. This results loosing some more follicles. So going ahead with treatment a better option.
Taking drugs like clomid without Follicular monitoring by scan is not advisable. Youhave to take it under suprvision of an infertility specialist.
I hope I answered your question. I will be available if you have any more concerns.
If no more queries, please accept my answer and close this discussion.
Regards,
Dr.Mahesh Koregol
Thanks for writing back.
By definition you can try for a year before being called infertile. But in your case you have been diagnosed of low AMH levels. When diagnosis is infront of us I dont see any need to wait. This results loosing some more follicles. So going ahead with treatment a better option.
Taking drugs like clomid without Follicular monitoring by scan is not advisable. Youhave to take it under suprvision of an infertility specialist.
I hope I answered your question. I will be available if you have any more concerns.
If no more queries, please accept my answer and close this discussion.
Regards,
Dr.Mahesh Koregol
Above answer was peer-reviewed by :
Dr. Yogesh D
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