Q: My wife is 27 years old and has a right ovarian cyst measuring 4.6 x 3.3 x 3.1 cms. She is undergoing treatment for conceiving (since we have had no positive results for almost a year now) where she takes Fertyl 100mg from the third to the fifth day and then on the fourteenth day, she is injected with HCG 5000 I/U. She has taken this treatment for 4 months now. The gynaecologist we used to consult is unwell and so we went to consult another one. The other one has prescribed following treatment: Letroz 2.5 mg, one tablet daily from the second to the sixth day, injection F.S.H. 75 on the seventh day, ovulation study and tablet Susten 200 1 HS from sixteenth day for 10 days. She has already taken Letroz for 4 days now. Please advise whether we can go ahead with this treatment. Is it safe? Will it help in her in getting pregnant?

A:You have given us no information except an ovarian cyst and some sub-fertility. The ovarian size is not too big and seems to be an after effect/complication of Clomiphene. At this stage you need a proper diagnosis and then a relevant treatment. You have not written anything about your wife's medical condition before you started the treatment. You need to specify whether you always had this ovarian cyst or did it emerge after the treatment with hormones. Both the treatments you are taking and the one you are going to take are extremely hazardous and should not be played around with unless you have a very good reason and under expert supervision in a tertiary centre. That means you should be monitored by Ultrasound and periodic hormone testing throughout the month. Besides it is very expensive. I am not sure whether you really need it all. Though with all the precautions complications can be minimised, this is certainly hazardous and should be taken only as a last resort. That means that you have tried all simpler methods and have failed to produce an egg. And this is advisable only if you have chronic anovulation (inability to make an egg) on a long term basis because occasionally i.e. once or twice a year most women do not make an egg and that is normal and not a disease. Drugs like Letroze are not licensed to be used in infertility yet but sometimes it is used but only in cases where all else has failed. Since you have started treatment only a few months ago, it in unlikely that you would need it. Similarly injectable hormones are hazardous and expensive and reserved for very refractory cases. In the short term these drugs can cause hyperstimulation (over reaction to the drugs which could be life threatening). In the long run all these can cause ovarian and other cancers, besides the real risk is of multiple pregnancies. I would advise you to get a clear diagnosis (find the exact cause of you sub fertility if any) and plan the treatment accordingly. You should regularly communicate with your doctor and make informed decisions about what treatment you take for your condition.