Suggest Treatment For Inability To Conceive

Posted on Fri, 30 May 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 30 May 2014 Answered on

Mon, 16 Jun 2014 Last reviewed on

Question : Hi, I am 29 years old and trying to conceive since last 6-8 months. Last year in Aug i had a 2 week chemical pregnancy as told by the doctors. The Beta HCG was 61, but Progesterone was 1.2 hence the pregnancy did not continue, my periods were then only 1 week overdue. The Doctor then gave them Duphaston from Day 17th to Day 28th of my cycle. We took the medicines for 3 months, and since then I am trying to conceive. My other test reports were normal as the doctor said. I dont know is it the stress of trying to conceive or something else. Please help me understand should i go for further treatment to the doctor or should i wait for some more time. I am taking DUphaston for the last 10 days of my cycle. Is it ok to continue it for another 6 months (hope it does not harm). Please advice.

Answered by Dr. Aarti Abraham (2 hours later)

Brief Answer:
AS BELOW

Detailed Answer:
Hello
Thanks for writing to us with your health concern.
You should definitely start taking treatment for the inability to conceive.
Duphaston will not harm you, you can continue it for another 6 months.
However, am providing you with a checklist of investigations, that should be done in your case stepwise -
1. Complete blood count, viral markers, TSH, OGTT ( sugar, thyroid testing ) , blood group of both partners.
2. Husband semen analysis.
3. Your follicular study - tracking of egg follicle by ultrasound scan every month to see if you are ovulating.
4. Hormonal tests for you - FSH, LH, TSH,AMH,
Prolactin, OGTT, DHEAS, Free testosterone.
5. If you do not conceive after 3 - 4 cycles of documented ovulation, go for a hysterolaparoscopy to check if the fallopian tubes are open.
6. If ovulation is not occurring, go for a course of ovulation inducing agents like clomiphene citrate
7. Always remain positive, modern technology can help you. Maintain ideal weight and take regular folic acid supplements.
All the best
Please feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (58 minutes later)

I have gone through all the above tests in Aug last year, and as per the doctor all the reports were normal.
In Feb this year also I had an instance where my Beta HCG was 11 as of 12th Feb (Period Due date : 15th Feb), but it subsequently dropped to 6 as of 17th Feb, and my Progesterone level was 1.1 on 17th Feb.
At that time I was not under the support of Duphaston. Hence, I again started Duphaston in March for the last 10 days.
Do you advise that I should continue with Folic Acid and then last 10 days with Duphaston ?
I am not able to understand the reason for this low levels of progesterone, may be I am taking too much stress, please advise is it Ok to continue with the above treatment for the next 3-4 months, and then we can see what further should be done.

Answered by Dr. Aarti Abraham (2 hours later)

Brief Answer:
as below

Detailed Answer:
You can continue to take folic acid with Duphaston.
You can try the approach for 3 months and then go ahead with the treatment plan.
I do not think all tests would have been done.
Are you sure you have gone for 3 cycles of follicular monitoring and laparoscopy also ?
Low levels of progesterone are intrinsic, they are due to individual hormonal imbalance.
Stress, weight gain , erratic eating and sleeping - all these do affect the hormones.
If you want to try naturally for 3 months, avoid stress.
Play, exercise, meditate, indulge in a favourite hobby .
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (3 hours later)

No I have not gone for follicular monitoring etc. But the other blood tests yes have been done.
Can i go for fol gel plus and duphaston for the next 3 cycles, or if u can advise any other medicine. ???
I shall try to destress myself and exercise as u said.

Thanks

Answered by Dr. Aarti Abraham (3 hours later)

Brief Answer:
AS BELOW

Detailed Answer:
You can take these medications for the next 3 months, they are safe.
THen proceed for the workup as outlined.
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar