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Friday, March 7, 2014
Dear Doctor, I`m trying for conception since 1.5 years. Almost all my reports are good other than thyroid. I do suffer from TSH of 5.01 ulU/ml,T4 of 9.40 ug/dl. My gynecologist wants my level of TSH to be down to 3 and recently increased my thyroid dose for this. Recently, I went through HSG which shows both my tubes to be open and uterus of normal shape. My husband`s sperm count is good (as told by my gynecologist). My gynecologist has denied that I should go for laproscopy and instead wait for 3 months in which she has prescribed some homonal tablets to increse my egg size (to be taken during my periods). I am confused because through my follicular study, my egg size was quite normal and I am very desperate for pregnancy. So should I force her to do laproscopy to diagnose any further problems? Recently I read about restless leg syndrome and it affects fertilty also. I do suffer from pain and stiffness in legs. I don`t know if it is the reason for my infertility. Please advise.
From your email, it is not clear what is stopping you from becoming pregnant. Common, problems that are often difficult to detect include cervical mucus problems, subtle ovulation problems, and endometriosis (which can only be accurately diagnosed by laparoscopy). However, the most important missing information is your age. If you are in your 20's, then trying ovulation induction pills for three months is reasonable. If you are over 35, then you might want to be more aggressive. Those in the middle need to decide how fast or slow to move on to high-tech treatments.
If you think that your evaluation and treatment is going too slow, tell your gynecologist. You can ask her to send you to a fertility specialist, if one is available in your area. Most gynecologists are glad to send you to a fertility specialist when you are ready. They usually are happy to more ahead more quickly.
William W Hurd, MD
Professor of Reproductive Biology
School of Medicine
Case Western Reserve University