I am trying to conceive for the past one year with autoimmune hypothyroidism. Please help.

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I have gone through all your reports (attachment removed to protect patient identity) and your prolactin and thyroid levels are well in control. What is missing in the follicular monitoring profile of the dummy cycle and also your husband's semen analysis test?

You have been following the correct protocol using LH kits for ovulation and post LH surge if a natural trial or timed intercourse did not work then husband's semen analysis becomes mandatory. Then when both male and female infertility causes are ruled out then comes mechanical causes where positions and version of uterus need to be considered and measures implemented. Anyways please send these two remaining reports before we can proceed further.

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I have gone through the reports sent by you (attachment removed to protect patient identity). Your reports of FSH and hormonal profiles are normal. But the issue is with your husband's semen analysis. His sperm motility index is low and also his functional morphologically sperms are also fairly low, only 8.7 million.

With these levels, even if you are ovulating naturally for him to allow you to conceive naturally with timed intercourse would be difficult as active motile normal sperms are low.

With these levels, and if you are ovulating naturally as tracked with LH kits, then IUI (intrauterine insemination) of prepared washed sperms would increase your chances of conception. Else he would need to be treated for next three months with antibiotics, sperm energizers and antioxidants considering the life cycle of sperm is 120 days (four months), but the treatment of three months bring the fresh swarm of healthy sperms to maturity for fertilization at third month and fourth month, they senesce or die. So both options are there for you.

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A healthy count for natural conception should be more than 50 million even though the WHO parapets say > 15 million (for IVF). The sperm motility index should be more than 80 and hence motility is hampered. The percentage of normal sperm morphology is 11% which is way too low. So, considering the life cycle of sperms is 120 days, the present prescribed regimen is for three months.

Treatment:

From day 1 to day 14.

1. Tablet Doxycycline 100 mg 1-0-1 for 14 days.

2. Tablet Ornidazole 500 mg 1-0-1 for 14 days.

3. Tablet Pantop-DSR (Pantoprazole) 1-0-1 for 14 days (half an hour prior to food).

From day 11 to day 40 (medicine overlap for four days from day 1 1to day 14).

1. Tablet Clomofine citrate 50 mg 1-0-0 for 30 days.

2. Tablet Fertisure-M 0-1-0 for 30 days.

3. Tablet Uprise 60K IU one tablet once a week for four weeks.

4. Tablet Becomax-C forte 1-0-1 for 30 days.

The above regimen to be taken for three months by the male partner.

As far as your pain in the labial region is concerned, it is sometimes seen during mittelschmerz during ovulation but not generally seen in women and should not be a problem in conception.

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Yes, the medications are only for the male partner.

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Usually it is not seen on all the days and if seen as whitish sticky discharge, it indicates a vaginal infection or secondary to possible cervicitis or vaginitis. In such cases a high vaginal swab culture should be done to rule out any infective cause and thereby treat it accordingly. Make a habit of using alkaline vaginal wash especially during menses and if such infection persists or recurs.

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Yes, a vaginal persistent infection can change your vaginal environment and make it acidic, and non conductive for sperms to travel.