problems in having second child

we are married since 1998 and had our first child in 2001.  my wife had to undergo an medically terminated pregnancy in 2002.  since two years we are trying to have a child but in vain.  doctor did semen analysis, hydrogenation and said everything is fine.  we have also done four-five cycles where the doctor gave injections on 14th day.  but still in vain.  tell us what to do.  we are very frustrated.  please help.

[Elaine Brown, MD]

Hi!
I'm happy to hear that you have a child already.  That usually makes the prognosis better. If you two were my patients, I would begin with ovulation predictors.  If those confirmed ovulation, I would check a progesterone level on day 21.  I would also check a thyroid value and prolactin level at this time.  A cycle day 3 FSH level would be helpful too.
If your wife is ovulating, and your sperm count is good, the next test might be a hysterosalpingogram to check the uterine cavity and the fallopian tubes.  If the fallopian tubes were open, I might recommend that you two consider Intrauterine insemination.
Also, A medication such as Femara or Clomid might be helpful.

I would probably try this approach for up to 3 cycles before going on to In Vitro Fertilization.

I hope this helps!

Dr B