Q: I am a 30 years old woman married for 4 years. After a year of my marriage, I tried to conceive but did not succeed. After my husband and I were tested, my husband's semen analysis was found normal but I was reported as hypothyroid. The doctor gave me medicine and within 2 months I conceived. But that was a blighted ovum and dilatation and curettage (D & C) was done. Then a year later I conceived again but had another abortion . The reports showed toxoplasmosis positive and CMV IgG positive. I am still on Thyroxine 150 mcg. Can I conceive successfully? The doctor told me to take Letroz 2.5 from 2nd day to 6th day and then Duphistan from 11th day to 25th day. Are these medicines safe? I had an ovarian cystectomy 3 years back. Please advise.

A:First, the thyroid needs to be controlled and checked out with thyroid tests like TSH level. If the toxoplasmosis test is positive in high titres, and CMV as well, they need treatment too prior to planning pregnancy. You will need rovomycin and erythromycin till the titres start to decline, The test can be repeated after 6 weeks following the treatment. Once these issues are settled, the occurrence of spontaneous ovulation needs to be checked by scanning of eggs from the 9th day of the cycle for three alternate days or till egg formation and rupture is seen. If the egg is developing normally and rupturing, coitus can be planned on day of rupture or after it till 3-4 days. If egg formation is not happening, then drugs like Letroz can be added as well. Once conception does take place, support with injection HCG 5000 units weekly and/or progesterone suppositories may also be needed to prevent a repeat abortion, along with plenty of rest and family support.