Q: I am 29 years old and conceived after taking Fertomid 100. I took Dubagest 100 mg for 25 days (without being tested for hormone level). But when I discontinued it for 5 days slight spotting started. After one week of spotting severe bleeding started and the fetus came out with blood. What went wrong with me? What precautions and tests should I undertake if I have to conceive with or without the help of Fertomid 100? My ovulation test was normal. After taking Fertomid 100 there were two follicles. After conceiving there was one fetus of 5 weeks gestational stage. Is it possible that sometimes fetus of gestational stage does not grow? If yes, what can be done about this?

A:Fertomid is sometimes given to women with unexplained infertility. But then it is usually combined with timed intercourse or IUI. Yes, sometimes the fetus can stop growing. This is called missed abortion. There are numerous causes for this, but in the first trimester we usually encounter chromosomal defects in the fetus, or if spontaneous abortion occurs we consider progesterone deficiency, and congenital infections. Ocassionally, antiphospholipid antibody syndrome (APS) can also be a cause. You will have to be tested for all these. I am sure you have already been tested for thyroid problems and diabetes. The chromosomal errors in the fetus cannot be tested now - for that the fetal tissue is tested when abortion occurs. If no error is detected after doing all the tests, treatment is largely empirical. If you do conceive again with or without Fertomid (but with ultrasound monitoring) I would advice you to take Progesterone preparations like Microgest or Naturogest 200 mg twice a day from 7 days after ovulation was documented by scan. Then get a serum beta HCG done around day 12 or 14 after ovulation to check whether or not you have conceived. If yes, then continue this drug, at same dosage till 12 weeks after your last menses. I also advice you against sex during the first 3 months of pregnancy.