Creator: Dr. Sameer Kumar
Published: 2019-06-22T12:09:25-04:00

Patient's Query

Hello doctor,

I was diagnosed with PCOS at 16, but have had successful pregnancies (other things I had zero breast change and less than once a day of milk production). We have never used any form of birth control yet our youngest is now almost 5. We have been actively trying for almost two years now. My periods during the last six months have been on time and consistent. I am 31. Why are we not able to get pregnant after two babies?

Answer

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology

Hello,

Welcome to icliniq.com.

As I have learned that your last pregnancy was five years back and that your menses have been regular since last six months and you have been trying for last two years without any use of contraceptive practices to conceive. This qualifies for secondary infertility treatment. Now the first thing which needs to be checked is to get your partner's semen analysis done to check for quantity and quality of sperms as of now. There are chances that the count may have gone down or the quality may have depreciated which can be treated accordingly. In middle age men, such male infertility is common and needs to be addressed first before a lady is subjected to tests and examinations for evaluation of secondary infertility. Hence, it is requested that you may please get his semen analysis and culture test done first and review with reports. In the meantime, you may send across any ultrasound pelvis reports or hormonal profile tests (from the last six months) that you may have undertaken for review (if the element of PCOS still persists or not).

Investigations to be done:

Semen analysis and culture for the male partner.

Differential diagnosis:

Male infertility.

Probable diagnosis:

Secondary infertility.

Treatment plan:

As per reports (awaited).

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Patient's Query

Thank you doctor,

I have attached the reports.

Answer

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

I have seen your report which you have attached. It just mentions your serum testosterone levels which are mildly high and WBC levels indicate a possible infection. However, to evaluate female infertility one must get the following tests done (the irony is men have just one but women have a plethora of tests to undergo).

Hormonal profile (day two of the cycle)- FSH, LH, AMH, serum progesterone, serum estradiol, serum testosterone, DHEAS, 17-OHP, serum prolactin, thyroid profile (which is normal in your case). High vaginal swab culture to rule out vaginal infections (detrimental to sperms), PAP smear, transvaginal ultrasound to rule out PCOD, anovulation, follicular growth, adnexal masses, size of ovaries, fibroid uterus, cervical or uterine polyps, hydrosalpinx. HSG (hysterosalpingography) to check for tubal patency. So, it is requested that you get your partner's test done first and review.

Probable diagnosis:

Secondary infertility.

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