Dr. Sameer Kumar
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been trying to conceive for the past six months without any success. I have done FSH, LHS, TSH, Prolactin tests (all normal). My AMH is 3.73. I have also done TVS where a 3 cm post fundal fibroid was found. My husband’s sperm analysis is also fine. What should I do now? I am really stressed. My cycle is 29 to 30 days and normal. I have hypothyroid and I am taking Thyronorm 12.5 for that.
Hello,
Welcome to icliniq.com.
If you have been on Thyroxine and your TSH levels are normal and your remaining hormonal profile is normal with optimal fertility and ovarian reserve as depicted by AMH levels , now you can opt for a dummy cycle where follicular monitoring can be done during mid-cycle to check for timely ovulation along with timed intercourse, which shall ensure that you are ovulating. Also, you can be started on prenatal like l-methyl folate and Ova bless tablet daily during this cycle to potentiate fertility in your case.
Continue Thyroxine daily and practice timed intercourse. during the fertile period. The fibroid being posterior fundal 3 cm and not impinging on to the endometrium, conception should not be an issue if HSG reports ensure tubal latency as well. Also, important shall be to check for any vaginal infections in form of white discharge or itching per vaginum or foul-smelling discharge, which is deterrent for sperm survival and needs to be treated first. Avoid use of soap while bathing for genital and vaginal cleaning, use only plain water or alkaline washes. Please share your reports for preview.
Regarding follow up
Patient's Query
Thank you doctor,
No vaginal infection and my doctor told me to try naturally for a few months more before taking any medicines. Should I wait till then or go for these tests right away? I use an ovulation strip every month to check ovulation, and it is happening normally. I have a feeling that my husband and I are having sex incorrectly. The sperm flows out and he does not always go that deep as we are more worried about timing it right than the actual act. Could these be the issue?
Hello,
Welcome back to icliniq.com.
If you are ovulating regularly then you should try naturally of course. If the sperm flows out then the chances of conception are decreased by 70 %, so best would be to place two pillows under your waist during intercourse so that he could penetrate deeper and gravity shall help to keep the sperms in. Also, once ejaculation occurs, then cross your legs tightly and turn laterally towards the right side and keep lying for 15 minutes before washing yourself with plain water. Practice intercourse multiple times during the fertile period. Once your ovulation tests come positive, the ovulation shall occur in the next 36 hours. So, ideally, intercourse should start 36 hours prior to ovulation and should last 72 after ovulation, called sandwich technique, which increases chances of natural conception to a great extent.
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