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

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 06, 2020 and last reviewed on: Jun 20, 2020

Hello doctor,

I am not able to conceive after trying for almost one year. I was diagnosed with pituitary microadenoma and I am on medication. My prolactin levels have now reached normal levels after two months taking medication.

I suffer from hypothyroidism and on medication. I have had this for five years now and it is well within the limits as per my endocrinologist now. This is due to an autoimmune disease where my TPO (thyroid peroxidase) antibodies were high during the diagnosis five years ago. My husband and I would like to know how should we best prepare for pregnancy and what to look out for. We would have preferred to visit the clinic. Unfortunately, I am not in a position to visit the doctor due to travel restrictions. It would be great to get in touch with a specialist.

I am currently on Euthrox 100 mcg, Cabergoline 0.25 mg once a week, and Folic acid 450 mg daily.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome to icliniq.com.

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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Thank you doctor,

I have attached my FSH, semen analysis, and husband's hormone analysis.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

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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Thank you doctor,

When we showed this report to a doctor, they said this is normal. What would be the normal range for a healthy count?

My sperm motility index - 76 is the count. Yes, we will go with the medication. How do we go on about it? Is the pain I mentioned previously is normal?

Ever since we started trying to conceive, I feel a pinching sensation down my vagina in labia majora and minora. No pain from pelvic muscles or anything. There is no specific time for this. It happens randomly and maybe before ovulation and one week after ovulation leading up to my mensuration cycle.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

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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Thank you doctor,

All of above prescribed medication are for the male partner only and nothing prescribed for the female partner. If I am not mistaken.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hi,

Welcome back to icliniq.com.

Yes, the medications are only for the male partner.


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Hi doctor,

Thank you for all your diagnosis. Can I know one last thing, is it normal to have cervical mucus present throughout your cycle? I usually have it throughout and not only during ovulation days. Colour of it is creamy or whitish and sticky on other days apart from closer to ovulation. Let me know if it is normal. Thank you.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

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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Hi doctor,

Can the above two conditions lead to difficulty in conceiving?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

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


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