Q. I am trying to conceive with irregular periods and egg problems. Please help.

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 01, 2020

Hello doctor,

I have been trying to conceive for one year. I am 30 years old. I have children already. Tracking BBT and LH to determine ovulation days (which I have found my peak). I had lots of irregular periods with 20-day cycles. Last cycle was 26 days. I want to try Clomid because I believe I may be having problems with the release of eggs. Please help.



Welcome to icliniq.com.

Before opting for ovulation induction in your case, it would be important to learn if your partner's semen analysis is normal on the first hand. Your cycle seems to be regularly irregular, which is often seen in cases of women with estrogen deficiency and the ones with progesterone deficiency. As you have mentioned that your thyroid is normal, but my primary concern with regards to ovulation remains the estradiol levels, FSH, LH, AMH, serum testosterone on day 3 of your cycle and serum progesterone on day 21 of your cycle.

Without having these reports handy, it would not be recommended to opt for Clomiphene citrate to induction ovulation. Please share your latest ultrasound pelvis as well to check for your endometrial thickness in proliferative or mid-cycle.

Also, app tracker for LH is futile, rather it is suggested if you can opt for LH ovulation kits to actually determine your LH surge during cycle as that would be more objective.

Thank you doctor,

I have ovulation kits that I use to find my LH peak. The app is what I use to keep track of things. I have not done an ultrasound, however, I will suggest that to my PCP. I did go to the hospital when my period lasted for eight to nine days and they prescribed me Provera based on the info we have now. What do you suggest my next steps would be to help improve my chances of conceiving?



Welcome back to icliniq.com.

Considering that you have been trying to conceive for one year now, you can be labeled as a case of secondary infertility. Going ahead from here, as I said the first thing we have have to rule out is male infertility factor partner's semen analysis after three days of abstinence to rule out any oligo, asthenosphere or teratozoospermia, all of which can be corrected.

Secondly, female factors need to be evaluated in detail.

1. Hormonal profile (day 3 of your cycle), blood tests should be done for the following :-

FSH (follicle-stimulating hormone), LH (lutenizing hormone), AMH (anti Mullerian hormone), Serum estradiol, serum testosterone, serum prolactin levels and on day 21 of your cycle check for serum progesterone levels.

2. Thyroid profile, which you have already done.

3. USG (ultrasound) transvaginal pelvis on day 5 to rule out any chances of polycystic ovarian syndrome or any evidence of fibroid uterus or endometriosis or adenomyosis. Hence the scan is always mandatory.

4. High vaginal swab culture and a pap smear test tor rule out any cervicitis or vaginal infection in the form of mixed vaginosis or candida infection which can change vaginal pH and can be spermicidal naturally.

If all reports are available and normal then we can further plan an ovulation induction with estrogen and progesterone support and mid-cycle hCG injection for inducing ovulation accordingly and offering you a timed intercourse or an IUI (intrauterine insemination) cycle depending on your husband's semen analysis report.

Please discuss with your PCP the above and revert back with reports.

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