#3 CASE SUMMARY
Infertility
Privacy Protected Case Summary
Trying to Conceive for 6 Years? What This 24-Year-Old Patient's PCOS Fertility Report Reveals
About the Couple
Patient Age:
24 years
Location:
Bangalore, Karnataka
Duration of Infertility:
6 years (secondary infertility)
Key Clinical Finding:
Polycystic ovarian appearance on ultrasound, Day 14 dominant follicle 11.7 mm (sub-optimal), endometrial thickness 6.1 mm (thin for Day 14)
Report Type:
Second opinion — post-surgical case with follicular monitoring
Comparison of Treatment Recommendations
What you were told
Diagnostic hysteroscopy and laparoscopy for infertility evaluation
What we recommend
Appropriate for this case. With 6 years of secondary infertility, irregular cycles, and a missed abortion history, direct visualisation of the uterus and tubes was a clinically sound step. The findings — normal uterine cavity and bilateral tubal patency — are valuable and rule out structural causes.
What you were told
Ovarian drilling performed during laparoscopy
What we recommend
Reasonable in the context of confirmed polycystic ovarian appearance and 6 years of infertility. However, ovarian drilling is most effective when ovulation induction with medications has already been attempted and has failed. The shared documents do not include a history of prior ovulation induction, which would be important to confirm before evaluating whether this step was premature or appropriate.
Expert Interpretation
This case involves a 24-year-old woman with secondary infertility, polycystic ovarian morphology, and a surgical history that has now ruled out tubal blockage and significant uterine pathology. While the laparoscopic findings are reassuring — both tubes are patent and the uterine cavity is normal — the follicular monitoring results on Day 14 point to a more immediate functional concern. A dominant follicle of 11.7 mm on Day 14 has not yet reached maturity, and an endometrial thickness of 6.1 mm is insufficient for implantation in a natural or stimulated cycle. Together, these findings suggest that ovulation is either delayed or not occurring in the monitored cycle, which is consistent with polycystic ovarian dysfunction. The absence of hormonal investigations — particularly AMH, FSH, LH, and fasting insulin — makes it difficult to assess the full endocrine picture. Additionally, no semen analysis data is included in the shared reports. In secondary infertility cases, male factor evaluation is an essential part of the workup and cannot be deferred. The next step in management should focus on hormonal profiling, ovulation induction with close monitoring, and confirming the male partner's fertility status before escalating to further procedures.
Previous Consultation
Treating Surgeon and Hospital
Dr. Humuresha,
Sagar Chandramma Hospitals, Bangalore
Medical Background
The Patien's records document the following relevant history:
- Secondary infertility for 6 years — she has had one previous pregnancy (ended in missed abortion, 2022)
- Medical termination of pregnancy performed following the missed abortion in November 2022
- Irregular menstrual cycles, duration 3–5 days
- Polycystic ovarian appearance confirmed on ultrasound
- No hormonal test results (AMH, FSH, LH, estradiol), semen analysis, or ovulation induction history included in the shared documents
Key Findings From the Report
Treatment and Procedures Performed
Diagnostic hysteroscopy
₹599
Free
Diagnostic laparoscopy
₹599
Free
Questions Patients Often Ask
What does a follicle size of 11.7 mm on Day 14 mean — is ovulation still possible?
A follicle needs to reach 18–22 mm before it is considered mature enough to release an egg. At 11.7 mm on Day 14, the follicle is still developing and ovulation has likely not occurred yet. In women with polycystic ovaries, follicle growth is often slower and more irregular than in a typical cycle. Ovulation may happen later in the cycle, or it may not happen at all in that cycle. Close monitoring over the following days would be needed to confirm whether the follicle continued growing and ovulation eventually took place.
Is an endometrial thickness of 6.1 mm on Day 14 a concern for conception?
Yes, 6.1 mm is below the 8 mm threshold that fertility specialists generally consider adequate for embryo implantation. A thin endometrium on Day 14 — especially in a cycle where the follicle has also not reached maturity — suggests the cycle is unlikely to result in a pregnancy without intervention. Endometrial thickness is influenced by oestrogen levels, which are in turn affected by follicle development. If the follicle is not growing at the expected pace, the endometrium often does not thicken adequately either. This is a pattern commonly seen in polycystic ovarian dysfunction.
What This Means for the Patient
- The surgical findings from your laparoscopy are a positive baseline — your tubes are open and your uterine cavity is normal,
- which means two common structural causes of infertility have been ruled out.
Get a Second Opinion From IVF Pulse
If you have been advised laparoscopy, ovarian drilling, IUI, or IVF and want to understand whether the recommended treatment is appropriate for your case, share your reports with IVF Pulse for a free review by our fertility specialists.
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