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

### input:
I have failed ICSI treatment?? Reason stated were there could be possible kochs still present after 8 months of ATT treatment in the past with AKT3. Now physician again putting me on AKT4 excempting ethambutol as i have reaction to this drug. Is it suggestable to go again with AKT4 along with DHEAPREG for ovarian reserve at the same time as AMH value is 2.9. OB/GYN says to continue this for three months and then go for laparoscopy to check for any healing. Please suggest is okay to go before i go forward with another cycle of ICSI or try naturally as suggested by second opinion when there is no problem with tubes and uterus there are also chances to conceive during this treatment.... Please suggest.

### output:

Semen hello, Thanks for writing in. Let me answer your basic concern first.  A.I. don't think you need to be treated for Koch's for the second time just on presumption that the disease may still be persisting. Currently, there are no proper set of guidelines to dictate when genital Koch's has to be treated. As a lot of tests used for diagnosis indicate only presence of bacteria but not an ONGOING INFECTION which is very important to differentiate. So I recommend you to not opt for it unless 1. Your RNA PCR for Koch in endometrial sample comes positive.2. There is direct evidence of Koch's on hysteria laparoscopy which your doctor will let you know.3. TB bacteria are seen on histopathology slide made from endometrial biopsy sample. Other tests done for Koch's should only support diagnosis but should not be the basis for unnecessary treatment.  B. I would also suggest you to not take DHEA prey as it is meant for women with very low ovarian reserve. Your AMH value which talks about your ovarian reserve is well above 2 meaning you have the good number of eggs in your ovaries.  C.It's difficult to opine regarding your chances of natural conception as you haven't mentioned your age and duration of infertility, semen report, indication for CSI, tubal function test report and other relevant information in your query. But if your tubes are fine and no ovulatory problem, semen analysis is normal, and if you are trying for less than 2 or 3 years you may try another 6 months. You may conceive naturally even without treatment, but it may take few months to many years which can't be predicted. Hope this helps. Take care.