Why am I not able to conceive?

Q: I am a 24 years old woman who conceived about 3 years back, but got chicken pox so I had to go for abortion. Now I am trying to conceive for the last one year, but no success. I consulted the doctor 6 months back and she found some milk still coming from my breasts. So I underwent prolactin and TSH tests in, which prolactin was found to be 26.82 and TSH was 2.88. The doctor advised me to take Cabergolin for 2 months. I get itching and white discharge from the vagina so the doctor advised Candid v 3 and T Locon T. I am taking Siphene for the last 4 months and underwent ovulation test on the 13th day; the left ovary was 2.3 x 2.0. Therefore the doctor gave me injection HCG 5000 I unit on the same day. The egg ruptured on the 14th day and the doctor prescribed Progynova twice daily and Fluterm, but still after 2 ovulation rounds I have not conceived. In the second cycle the doctor gave me Folvite and Hald 200 with HCG injection, but in vain. I have also undergone the RT test for, which shoulder pain was positive. What is the problem with me? Are there any more tests I need to get done?

A:You wrote that there is some milk like discharge from your breast. It is a common enough condition especially after a pregnancy and a lot of women have it for a lifetime; in itself it is not a problem and should not be treated as a disease. The prolactin level you wrote (26) is normal and why you have been given cabergolin is not clear. Cabergolin is a very potent drug and in no way required for you with a normal prolactin level. In effect if you take it you are likely to have problems like vaginal dryness and infections, which you did have. This would further interfere with your conceptions. You also wrote you were given clomiphene but it is not clear why? Were you ovulating without it? Was it ever checked? If you were ovulating without clomiphene, clomiphene would decrease your chances of conception, besides causing side effect ranging from life threatening hyper stimulation to lesser problems like indigestion and overweight. So it is not only useless it is harmful. So please make sure you actually need these drugs. Take them only if they are absolutely essential and that would be if you do not ever make an egg without them. I hope you are not being given these just because something must be done and some fertility drugs are required. What you need is to make a diagnosis first, and for that we need to understand that by and large only three things can prevent you from conceiving.

1. Either you are not making an egg every month (anovulation).
2. Or the sperms are inadequate or abnormal (the male factor).
3. Or the two do not meet each other as the tubes are blocked.

Besides these three there are various subtle factors, which we understand little but may contribute to conception, starting from the pH of the vagina to the contents of the cervical fluids, and the thickness and nature of the lining of the uterus. They are difficult to pin point or diagnose so go largely under the heading of unexplained infertility. The second factor, the male factor should be ok if you conceived with the same partner 3 years ago as sperm do not become abnormal in that short a time unless there has been a major testicular disease. You need to check for ovulation, which in a 28-day period can be checked with day 23-serum progesterone more accurately than an ultrasound. And if that is normal you do not need drugs to make an egg like hormones and clomiphene, for tubes you need not do anything at this stage as all tests are invasive, (both hysterosalpingography and laparoscopy are invasive) and it would be safe to assume that your tubes are open as you had a normal conception 3 years ago. I think you need to believe that regular and well-timed sex is what is required for conception and not random unscientific combinations of the so-called fertility drugs.In due course it may take months (12 to 18) to conceive in most couples and treatment without a proper diagnosis will actually decrease your chances of a normal conception. There are many problems with the kind of treatments you are taking. You may find this difficult to believe but to give you a few examples of how it interferes with conception.Vaginal ultrasound is done to monitor the growth of the follicle by putting condoms over the transducer, these condoms in most cases are lubricated with a spermicidal lubricant. (Most condoms in the market have spermicidal jelly in the original packing) this obviously kills the sperms when you have sex on the right days when the egg is ripe.The stress of infertility treatment makes the sex therapeutic and takes the spontaneity and the fun out of it making it a mindless chore, which decreases both the frequency as well as the timing of sex. Sex on demand or on command puts a lot of pressure on the male partner affecting his performance, and there is lot guilt if not able to perform on the right days. Similarly, giving clomiphene, if you are making an egg on your own without it, creates problems. Though you make many eggs with clomiphene (instead of one which ripens in a normal cycle) the eggs are of poor quality and by giving HCG arbitrarily when the egg is above 20 mm may release unripe or immature eggs, which are not good enough to fertilize. So as you can see a lot of your problems have been created by too much ‘treatment’. You did not conceive but had a lot of side effects. Please see if you ovulate without any drugs. Get a post menstrual ultrasound (US) done to rule out problems like polycystic disease and get serum progesterone on day 22 or 23 of your next cycle without any drugs, in case you have a 28 days period and see if you ovulate. This is a more accurate test than ultrasound to confirm ovulation. If you ovulate without drugs please stop all ‘medication’ and try on the right days for at least 6-8 cycles. Get a clear idea of what the fertile period is and try on the right days.