To what we should investigation the couple before initiating Clomiphen or Letrozole

Age of the female factor is the guiding factor.More she is aged and mote the yers the couplehave spent for trying natural preg --> more dertaled should be investigations.

·         . 2 on CC :-Causes of CC resistance or CC failure & how  much to investigate before commencement of CC ??

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·         How minimum is too minimum.?

·         Ans:-If we initiate CC with minimal investigations it is very likely that a fair number of cases will fail to achieve preg( ovulates—CC failure  / anovulation-CC resistance) .t is needless to mention more cycle turns out to be futile more will be the stress and frustration f the couple. To avoid this clue of repeated disappoinemts it is a fair  practice to investigate a couple  properly as far couches funds permit and initiate the cc ,though age of female partner is remains a deterring factor too. The she is aged more Jerauld wall be the list of investigation to avoid disappoint with CC or letrozole . In. such a situation will add to the stress which was already existent with subfertility problem CC failure/CC resistance & associated disappointment and despair with every futile cycle:-They become disappointed irrespective of female partner’s age and cause of anovulation. We know that most of the cases of anovulation . We know clomiphene is used mostly in the  type of anovulation which come under the broad heading of HPO dysfunction . This WHO dysfunction which is described in the text books as  HPO axis deviation may be due to different causes  and   not at all related to LH hyperfuction. For instance , such WHO class II ovulatory disorders may also be due to which may be due to 1) excess insulin or 2) normal peripheral insulin but accompanied resistance, relatively subtle 3)  raised androgens, abnormalities 4) leptin-adiponectin disorders, 5) low SHBG 6) low AMH 7) undiagnosed transient hyperprolactinaemia or 8) subtle adrenal diseases  9) minimal endometriosos .CC failure may also be variety of tubal, tub peritoneal abnromalirs , including about 12 kinds of uterine anatomical/ physiological dxefects.sometimes very high unaccounted high LH.