Brief Answer:
Your infertility and abnormal menses are most likely due to not ovulating.

Detailed Answer:
Hello, My name is Dr. Brown, and I hope I can answer your question.

Just because all your hormone tests came out normal, and your husband's sperm is normal, it doesn't mean you do not have a fertility problem. Unexplained infertility, which is inability to conceive for one year (having regular unprotected sex at least every few days) is the most common situation for infertile couples.

I do not know what products and treatments are available to you in your country but I can outline suggestions for you of what I would recommend if you were my patient here in the U.S.

First, there are kits and devices that can check to see if you ovulate. In the US these can be purchased at a pharmacy without a prescription. Most of these devices or kits advise testing midcycle, when a woman typically ovulates, but you should test every day starting on day 7 of your cycle until you get a positive result or 35 days have gone by, even if you are bleeding. You may need a few kits to have enough test strips to do this. If you find you ovulate, it is a good sign and you may need to adjust when you try to conceive. If you do not find that you ovulate, weight loss of as little as 20 percent of your body weight can resume normal ovulation in women with irregular cycles, or you may be able to be treated medically to help you ovulate (see below)

There are medications that can be used to help you ovulate. Clomiphene citrate is a widely used fertility medication that has minimal complications that may be an option for you as an initial trial. It can be combined with intrauterine insemination to increase chances of pregnancy. These treatments can be done at any age and since you have already tried to conceive for 2 years it is a reasonable plan to at least try before referral for IVF. Even injectable medications that are stronger than clomiphene can be prescribed by a fertility doctor.

In addition, if you have not had evaluation of you fallopian tubes to make sure that they are open, that can be an explanation for inability to conceive that was not yet explored and should also be discussed with your fertility doctor. A test called an HSG (hysterosalpingogram) is an xray test of your tubes that can determine if there is any blockage.

Acupuncture has not been proven in any scientific studies to have any hormonal effects or be effective in treating irregular periods, infertility or other female problems. It is proven to work for treating pain, but other than that, I do not recommend it as being beneficial or a substitute for Western treatments which have statistical evidence of success.

Obviously it is best for you in order to conceive successfully and have a healthy pregnancy that you lose weight, but, at least in the US, it is not regarded as a contraindication to fertility treatment. I cannot say if it is possible for you to conceive on your own, but if you are approaching 40 I would not wait longer to track your cycle alone without at least using ovulation kits, and I would consider getting a second opinion from a different fertility doctor who might be more aggressive in treating your problem.

I wish you the best of luck in conceiving and that this information was helpful.

Take care, Dr. Brown.

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Brief Answer:
This is a very encouraging sign, but not a guarantee.

Detailed Answer:
Hello again. I am glad you have seen evidence of ovulation, this is a positive sign!

You should certainly try with the kits for a few months and see what happens.

From the time it turns blue, have sex every other day until 7 days after. Sperm lives up to 72 hours in the genital tract, and the egg can take 72 hours to be released after your LH surge, so to be safest you should have sperm around for at least 7 days after you ovulate. If you find out you ovulate around the same time every month, you can stop using the kits and just have intercourse every other day from a week before you typically ovulate until a week after.

I would not continue to try much longer on your own, however, without having the test to see if your fallopian tubes are blocked. If you have blocked tubes, you will not conceive no matter what without IVF or surgery on your tubes.

As I explained before, unexplained infertility is the most common diagnosis of couples, even if you have normal testing and do everything right, you may still not conceive. There is no way to determine anyone's fertility potential in advance... ever... the only way to know is to try and see what happens. I would not try on your own this way for longer than another 6 months and then you should consider fertility treatment by a specialist, especially once you turn 40. IVF is the most successful treatment for unexplained infertility. I know that IVF is costly and involves a lot of hormones, shots and doctor visits, but obesity is not a contraindication, at least in the U.S., and if your goal is to get pregnant, waiting and seeing longer than 6 months, especially if you are over 40 by then, is not what I would recommend.

So I hope the kits help you time your efforts more effectively, but if they do not I would not delay treatment by a specialist more than 6 months more, even if you haven't lost weight. It does not mean you are less of a person if you cannot conceive "naturally" without treatment. It just may mean that you have an illness, like any other, and you may need medical treatment to get better.

I hope the ovulation kits help you and if not, you find a specialist who can help you get pregnant. There is a lot of amazing technology out there to help women conceive, and I hope you can find a specialist to work with who can help you finally achieve pregnancy.

Best of luck again, and feel free to contact me further if I can help you in the future.

Sincerely, Dr. Brown

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