### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Dear Mam/sir , My Name is neetu Datta (38). I have a daughter who is 12 yrs old. delivery was by C- section. one year after the delivery I conceived again but due to some reasons there was miscarriage ,After this me didn t try to conceive again till 2005. none for last 7-8 years we are trying w/o any luck so far. in 2007 I was operated for endometriosis which was successful. on the advice of doctor ,I also got the HSG done to check of the tubes are fine and even that was also reported to the fine But despite of many tries, I couldn t conceive. Finally we decided to go for IUI(2009), but still no luck.all the test on my husband were also O.K. very recently also we got the IUI done again, but still no result. I am writing this to you to get your valuable advice in this case. I will be very grateful if you can give me an appointment to meet you and discuss the case. I have heard a lot about you. Request you to consider my case. Last week I had gone to AIIMS, and was suggested to get AMH (ANti Mullerian Hormone) test done. I got this test from Dr. Dang s lab (Delhi-Hauz Khas). Result is : 0.37 ng/ml Infertility work up baseline TVS Right Ovary size 17.9 * 13.3 * 16.8 cm AFC 5 Vol 2.4 Laft Ovary size 17.8* 14.6*15.4 cm AFC 3 Vol 2.1 kindly suggest if can be improved with medication , and whether I will be able to conceive naturally? Thanking You Neetu Datta

### output:

Hello NeetuThank you for your query and for your detailed history. Firstly, your chances of natural conception are quite less. You have already had surgery for endometriosis, and HSG is not always reliable. Your tubes could have suffered a damage, which is best confirmed by a diagnostic laparoscopy.Also, endometriosis surgery affects the ovaries, leading to decreased ovarian reserve. Age 38 also causes decreased efficiency of ovaries to produce eggs. This is reflected in both your AMH, which is very low, and your AFC, which is low too. With these values, it would be foolish to wait for natural conception.Also, your husbands' semen analysis needs to be done.You have two options - either straightaway go for IVF (in vitro fertilization) or go for a diagnostic laparoscopy and maximum 1 -2 more cycles of GUI if findings are normal, and then IVF. Please consult a leading Infertility specialist in Delhi take care.