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Why am I not getting pregnant?

Q: I got married 2 years back and trying to conceive for the past 2 years. I have history of irregular periods before marriage. I was started with clomiphene. Initially it was not effective. Prolactin level seemed to be elevated. Hence I was taking Sicryptin along with clomiphene. In one of the past cycles, my HCG test turned to 3/4 positive. In that cycle I was put on microgest (progesterone). But as it ovulated late (after 20 days) that didn't stay. After that cycle, was put on clomiphene, sicryptin, gonadotropins alone. I ovulated, periods came regularly, but didn't conceive. I have a doubt that my hormones are misbehaving. If there is a progesterone induction will my chances of getting pregnant boost up? If so, from when I have to take? My husbands results are positive.

A:The information you have given in the mail is incomplete. There is no mention of a diagnosis; you have just said that you have irregular cycles and have raised prolactin. Please write specifically, what is the exact level of prolactin. With irregular cycles, if the prolactin is very high, the cause of inability to form an egg is quite different from that if the prolactin is only raised marginally. Borderline raised prolactin with some other symptoms and signs is because of PCOS which will also cause anovulation (inability to make an egg every month). In either case you need to clarify with you gynaecologist whether sereptine is being given as a primary treatment or just an addition to the clomiphene/gonadotrophin treatment. Both these therapies are given, but as I said the most important thing for you is to first get a proper diagnosis. You have told us about your treatment details and a lot of technical terms which I am not sure you understand fully. Well, whether it is PCOS of hyperprolactinaemia (primarily) you have a very good chance of having a pregnancy with proper treatment especially since you say your husbands results are OK. The chances of conceiving or carrying are NOT MORE with progesterone pessaries in evidence based studies. Only in some selected cases it is used to enhance the rates of pregnancy and your does not seem to be particularly suitable. In the end you must understand that with best of treatment and prompt ovulation your chances of conception are only about 20% in one cycle, 40% in three cycles and about 60 to 70 percent in one year. So please be patient and do not expect to be pregnant in every cycle that you ovulate. Even nature does not give you that chance. If you expect to get pregnant in every cycle you get treatment for, you will be repeatedly disappointed and that will add to the considerable stress, you must already be undergoing, of infertility and its treatment. Be realistic and patient. Your hormones need to be perfect for only one cycle for you to have a normal child and as you know the beauty of a females hormones is that everything changes every month with each menstrual cycle. So even without any treatment there is a fair chance that you will eventually conceive as most minor imperfections of menstrual cycle are self correcting in nature.

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