Irregular cycle & incomplete investigation

Dear Lord Winston,
Thank you for looking at my question. I am 29 and have been trying to conceive with my husband (31) for nearly 2 years. I have my next appointment with my consultant next week and I want to meet him knowing if there is anything I should be asking for, rather than just accepting what he tells me.
As a brief background, my key issue is very irregular and long cycles (between 40 and 90 days). I have had multiple blood tests which show I do ovulate, it can just take a very long time. Most other blood tests and an ultrasound were normal. However, my AMH was high @ 36.8pmol/L and I have an inverted LH/FSH ratio which indicated possible polycycistic ovaries but ‘we can’t prove it’ (words of my consultant – due to no other physical indicators or indicators on the scan). My consultant felt the best course of action would be to go take clomid (50mg) to regulate my cycles. I have just finished my third clomid cycle with no pregnancy, however my cycles have regulated and all were 27/28 days long with day 21 progsterone 48nmol/L. The only other issues I’ve had were an eroded cervix (which I had surgery for), vulval vestibilitis and ME (for 3 years approx 10 years ago). The Consultant advised there wasnt any indicators that would mean I would need the HSG test and he hasn’t mentioned a laparoscopy. Are those things you think might be helpful? (I know you can’t give a full diagnosis with the info I’ve given but I’m convinced they’re going to say there is no reason to have the tests and I’m not sure how to convince them otherwise and if it’s worth trying to convince them).
Also, All the Drs have advised my husband’s sperm tests were normal but the motility is 40%, forward progression 34% and morphology of 4% – all of which are in the normal range but seem to be on the lower cusp. Is this something we should be more worried about? He is healthy, doesn’t smoke, not overweight etc.
Thank you for any help or advice you can give, S.

Dear S,

I am afraid – you probably know this already – that I am not at all in favour of incomplete investigation and do not believe that people should have treatment for any condition until every reasonable attempt has been made at trying to establish a diagnosis. Of course you may have PCOS – but this is so common it could be that you have another problem as well and I think that, particularly after failure of the clomid – there’s a strong case for both an HSG and a laparoscopy. Laparoscopy can allow ovarian biopsy and this itself triggers successful ovulation in a number of women like yourself.

I understand the object of not doing all this is the laudable reason of trying to save money. But if your treatment fails and you then go for IVF (which at best can only have in the region of a 30% of successful live birth), much more money will have been spent either by the NHS or, of course, by you.

I am afraid I don’t understand the phrase ‘morphology is 4%’ – does that imply that only four percent of his sperm are normal? How many times has this cheap test been repeated and have sperm function tests been conducted?

Best wishes
Robert Winston