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Is Premature Ejaculation Bothering You?
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Dr. Aniruddha Malpani
Renowned infertility specialist. He runs an infertility clinic in Mumbai and has written many books. Have a question? Click here...
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Perimenopausal
 Jolly asks,
I am 45 yrs old. I have menopausal symptoms since the last three years. Now from the last three months I missed my periods and got it this month. When I have my period it's absolutely normal and there is no pain. Only thing is, I miss it on and off. I am on Ayurvedic treatment clubbed with Regestrone, Naturogest tabs at times to regulate my periods. I have Thyroid and I am on Thyroxin 25 mcg. Recent test shows my TSH level is 5.54. Also about two years back ultra sound showed an ovarian cyst and few fibroids.
I wish to know how long my periods can continue with medication and I can remain fertile. I am single but plan to settle soon. I am late in life but have desire for kids. If not by normal method is there any alternate ways to have a family? What does it cost? Can my partner and I take help of fertility banks so that we can have a family as and when we settle? My partner is 46 yrs old.
 Dear Jolly,
Your age and your irregular period suggest you are now perimenopausal. This suggests you have poor ovarian reserve. Your next step is to do a clomid challenge test to assess your ovarian function (reserve) because you may have reached the Oopause.
This is the way to do the test:
- On Day 3, you need to do a blood test to measure your levels of FSH, LH, PRL and TSH. Do these from a reliable lab please - for example, Specialty Ranbaxy.
- Take 100 mg Clomiphene citrate from Day 5 - Day 9.
- Repeat the blood test for FSH again on Day 10 and then email me the reports.
- If the Day 3 plus Day 10 FSH levels are more than 25, this suggests you have ovarian failure, and that donor egg IVF would be your best treatment option, if you are willing to consider this.
- You can take HRT (hormone replacement therapy) if you want to continue having regular cycles.
Non-Obstructive Azoospermia
ABC asks,
My wife and I are trying to achieve a pregnancy for sometime now. We did all the required tests. My wife seems to be ok. But I am the one with the problem. Doctor has diagnosed that I have Azoospermia. I went through a testicular biopsy on both testes. And nothing was found. Doctor is not hopeful and has advised us to think in terms of IUI or adoption. So we are thinking about a donor sperm. What do you suggest we do?
Dear ABC,
You have non-obstructive Azoospermia. The question is if it is partial or complete testicular failure.Your choices now include: TESE-ICSI where there is a 20% chance of finding testicular sperm on multiple testicular biopsies, if you are willing to use donor sperm as a backup. This treatment is expensive and takes about 20 days.
Ultrasound Scan
Gayatri asks,
I am six weeks pregnant. I have done a sonography few days back and the heart-beats are 112 per min. Due to these slow heart-beats the doctor has started hormonal treatment i.e. Ovigyn 5000 twice in a week and Naturogest cap 200 mg daily twice. Is the injection stated above fine? Are there any side effects? I have no history of miscarriage but an ovarian pregnancy 4 yrs back.
Dear Gayatri,
I don't think these medications will help at all. Please repeat the ultrasound scan after 1 week. It's quite likely that the heartbeat will become stronger with time.
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