Q: I am a 33 years old female completed 6 months of pregnancy. My weight is 83 kg and height is 150 cm. In 6 weeks USG, there was no fetal pole found, but after taking HCG injections and progesterone tabs, the USG after 10 days shown fetal growth of 7 weeks and 3 days. In 16 weeks also, USG shown heart beat & fetal activity good. But till 6 months I am taking gestone injections once in a week, Dubagest 200 mg tabs twice daily vaginally and Eltroxin 0.5 mg daily. I feel fetal movements daily. But now I am fearing will this baby be normal or not. I have polycystic ovary and a fibroid of 3.3 mm x 2.7 mm in 16 weeks USG is there. Please advise.

A:It is more important to know why these hormones were prescribed to you. According to Cochrane Data base, the most reliable source in our business, there are some small studies without proper controls, which claim improvement of the chances of survival of pregnancy with Injection HCG in cases of recurrent abortion (in case you have had more than 3 abortions in a row). These studies were sponsored by the drug company marketing these drugs and larger well-controlled studies have not shown an improvement. The editors suggest that until more independent evidence comes these drugs should not be prescribed except as a part of a trial (experimental), in which the patients’ volunteers to be a part of the trial and understands all implications including limited and unconfirmed benefit of its use and possible complications of taking the drugs. So I am not sure that you have recurrent abortions or that you are a part of a clinical trial (you have not written). In case, you do not have a history of 3 or more consecutive abortions, there is no logical reason I can think of for taking these hormones. At the outset I want to clarify that there is a difference between growth, which is used to express development of the fetus and structure (the formation of the fetus). The fetus is formed with one sperm and one egg and the structure is decided by and large at conception itself. A drug or medication can cause structural abnormality but there is no way it can correct a malformation. So there is no medical/scientific reason to give any drug or hormone to improve the baby or to correct a fault in the formation of the fetus. So, if the baby is not formed there is no way a hormone in form of injections HCG or tablets of progesterone can form a fetus. So when you say on Ultrasound no fetal pole was found does not mean that fetus was not formed and it appeared miraculously at 7 and a half weeks with hormones, it only means that no pole was seen on ultrasound. Now at 6 weeks (the time you had your first scan) the fetal pole is often not seen on ultrasound, and the only treatment required was to scan again at or after 7 weeks, which is what was done in your case, and fetal pole was seen on Ultrasound as expected. When a fetal pole is seen depends on the quality of the US machine, whether abdominal scan is done or vaginal (internal), and on the observers (the US doctors) dexterity (training and experience). So fetal pole was not seen at 6 weeks because at that stage it is generally not seen especially if there is a discrepancy of dates like in PCOS, and in no way this proves your pregnancy was abnormal. Then why so many hormones were given to you is something only your treating physician can answer. He/she obviously knows more about your case than you have written in this letter because from what you have written I cannot understand what the justification is either for the early scan (at 6 weeks) or for giving the hormones. The second aspect is growth, again no way can hormones increase or accelerate growth or even prevent growth retardation. It is theoretically impossible. The two terms are not synonymous, though they are related as most abnormal fetuses will show growth abnormalities but this appears after the pregnancy 5th month and not at 6 weeks. Now coming to your doubt, I said that hormones including progesterone are potentially harmful does not mean that they will always cause harm in all cases. They should be avoided but since you have taken them you do not have to lose your nights sleep now. In medicine we always talk in terms of possibilities, as nothing is definite. From your letter it is obvious that you are overweight and have hypothyroidism (thyroid deficiency). Proper correction of thyroid disease is extremely important as this may effect the fetuses’ physical and mental development. Please get a TSH done regularly and adjust the dose of the thyroid hormone accordingly, in consultation with a good endocrinologist. The requirement generally increases as pregnancy progresses and frequent adjustment of dose is very important.