How to get pregnant?
Patient: hello please help me i am thirtey years and have daughter from year and half i am trying and my husband to have another baby we went to the doctor he do ultrasound found mild pco but he says it is normal he do hsg and find patent tubes semen anaylsis is normal so he give me clomid and hmg and hcg injection but pregancy does not occur another doctor give me tamxiofen 20mg as once tablet from second day of period for 2 months but pregancy does not occur  my prolactin level is 15 fSH level is 5.6 and LH level is 5.6 what can I do next Doctor: HiYou have not mentioned about the day 21 serum progesterone level ( suggests about ovulation)It is reassuring to know that rest of  your baseline subfertility investigations are normal.What is your BMI? Do you have regular cycles? Usually women with PCO have irregular cycles as they do not have regular ovulation. I suggest that you take clomid/tamoxifen +Inj HCG for six cycles along with ultrasound follicular study. Ultrasound examination helps us to make sure that ovulation is occurring. If conception does not occur with this treatment then I would discuss with you two options of management. Either to start induction of ovulation with hormones or laparoscopy and ovarian diathermy for polycystic ovaries.Pregnancy rates between laparoscopic ovarian diathermy after 6 to 12 months follow up and six cycle of ovulation induction with gonadotropins are the same. Laparoscopic ovarian diathermy carries the risk of surgery. However, the rate of multiple pregnancies is lower in women who conceive after ovarian diathermy.Take one tablet of folic acid daily.To increases your chances of pregnancy, maintain normal BMI, quit smoking ( if you are a smoker) and have intercourse atleast three times in a week. For women with PCO maintaining normal BMI extremely important. Even reduction of just 5-10% of body weight corrects the hormonal imbalance and improves chances of conception.I hope I have answered to your satisfaction.If you have any further queries feel free to contact me through health care magic