Dr. Uzma Arqam
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 had secondary infertility for two years. I have a child who was born six years ago by cesarean. I did not have issues conceiving her. We started trying for the second baby four years back. I conceived within a month of trying. It was an ectopic pregnancy in my right tube and was treated with a tablet Methotrexate. One year later, we met a fertility specialist who suggested a few tests. There were no apparent concerns except that TSH was slightly elevated, and the right fallopian tube was slightly dilated. Persistent fluid was observed in the ultrasound. Also, I do not have a history of STDs. I was prescribed the tablet Clomid three years back.
Fourteen days DPO, I found out I was pregnant, but my hCG levels were extremely low. They did not rise appropriately, and the pregnancy was diagnosed as PUL suspected ectopic, and was treated with tablet Methotrexate. We tried IVF the same year. My doctor said a cesarean scar defect required surgery, during which they removed my right tube. My left appeared normal and was confirmed open previous HSG test. We planned for FET (frozen embryo transfer) the next year and transferred a 6AA PGS normal blast. A small amount of fluid was persistent that got cleared with progesterone administration. HCG levels were only 8.9 mIU/mL. Two days later, they were 12 mIU/mL. I was advised to stop medications and my periods started, but then the levels rose appropriately, so I went back on medications. Pregnancy did not occur, even though the levels rose but started decreasing on their own. The diagnosis was PUL but suspected ectopic. I have three embryos left and will be doing another transfer. But I feel like there is something wrong that they are missing. Being a fully hatched embryo, it had to be implanted before having time to float to my tube. I am worried about endometrial receptivity. However, my doctor is not recommending ERA. But he is unsure as to why this keeps happening.
Kindly advise.
Hello,
Welcome to icliniq.com.
I understand your concern.
Many factors are involved in the natural conception process, which sometimes go wrong if the treatment goes wrong. I suggest you to go for complete treatment for any of your health issues. It would help if you had a balanced diet, weight, and BMI (body mass index). The hormonal imbalance needs to be sorted out by a fertility specialist. Also, blood pressure and sugar levels must be within normal levels. It would help if you get your folic acid levels checked regularly. If there is any pelvic pain or fluid inside the tubes, it must be checked for infection and must be treated for conception. I suggest you to discuss all the details with the treating doctor.
I hope this helps.
Preventive measures
Regarding follow up
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Obstetrics and Gynecology
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