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Can I conceive normally or do I need injections?

Q: I have been married 5 years, but we started trying for a baby 2 months back. My period cycle is more than 40 days. We have done all the tests for both of us and everything seems to be normal. Last month I produced an egg normally and on the 18th day the doctor gave me an injection to rupture the egg. I ovulated but couldn't conceive. This month doctor prescribed me Siphene 100 mg and 4 eggs were formed. One of them has now grown very big (33x26). The doctors say that this will not be fertile but the others are. If I was able to produce the egg normally, then why did the doctor prescribed Siphene 100 mg? My period is more than 40 days, does that mean I cannot ovulate normally (without injection)? What happens if the follicular membrane does not rupture normally? Will the egg die automatically or will come through the periodic cycle? Since one egg is very big now, will it create problems, if I conceive with the normal egg? Do I really need Siphene 100 mg or any injection to rupture the membrane?

A:At the outset let me clarify that it is difficult to give you exact answers, and the best person to answer your questions is your treating doctor. Conceiving is really a complex process for which numerous factors have to be in sync. It is difficult for me to explain all these as there are volumes of books written on the subject. However: 1. Sometimes, even if the egg is produced, it may not be reaching right size, and as a consequence, one fails to conceive. Sometimes, one gives Siphene empirically, when all other tests are normal. 2. Keeping in mind your cycles of 40 days, I think you have a problem of ovulation. Ovulation does occur occasionally and erratically in women with prolonged cycles, and you may have ovulated in the cycle you were monitored. If the egg membrane does not rupture , pregnancy will not occur, and that follicle goes waste after 14 days. 3. Your doctor may withhold the injection for ovulation this time. I would suggest you just wait and watch what happens to these eggs in this cycle. Normally, one does monitoring with serum estradiol as well, to avoid problem of hyperstimulation of the ovary and its complications. 4. In my opinion you require Siphene and injection for ovulation. But monitoring should be with ultrasound, hormonal monitoring (blood tests) and postcoital test.

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