Infertility- Frequently asked questions
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A couple is said to be “infertile” when there is no conception naturally happening, despite contact (intercourse) regularly for a year.
Investigating a case of infertility?
If you have been trying to conceive for more than a year of regular contact with your partner and it has not been fruitful, it is time to see a doctor.
Whom to consult?
You ( couple) can consult a gynecologist or an infertility specialist.
When to consult?
For a thorough infertility work-up to be done, both the partners must be available together to meet the doctor. This will not only help in examination of both the partners, but will also help with a combined discussion of the issues faced by the couple and sorting them immediately with medical help.
The best time to see a doctor would be soon after the menstrual cycle of the female, preferably day 2 . The doctor can send a few investigations like FSH, LH, etc., which are more accurate during day 2 of cycle and also start treatment with ovulation induction from this time.
What does the doctor do?
You will have to undergo a general physical examination and a local examination as well. Your height, weight, pulse, blood pressure will be recorded. The heart, respiration and abdominal system will be checked.
A pap smear and a vaginal swab may be done for the female partner.
What are the investigations required?
Female partner needs to undergo a series of tests:
- Routine investigations like complete blood count, urine tests, liver and renal function tests, blood sugar, thyroid profile, HIV, HBsAg, VDRL, HCV may be needed to evaluate the general health
- Specific investigations to rule out specific causes are also needed.
They can be
- FSH, LH (On Day 3 of the cycle) to know about ovulation.
- AMH: To look for the ovarian reserve, indicates the feasibility of egg production
- Estrogen and progesterone levels : to regulate the hormones for reproduction and maintenance of pregnancy
- Prolactin levels : in cases of irregular cycles
- Testosterone levels: to rule out hormonal imbalance
- Ultrasound of the abdomen and pelvis to check the uterus, ovaries, endometrial thickness, rule out fibroids, etc.
- HSG- hysterosalpingography to check the uterine cavity and tube patency
- SSG- saline sonosalpingography- to check the tubes patency and uterus on ultrasound
- TB PCR- to rule out endometrial tuberculosis as a cause of infertility.
- In certain cases, surgical interventions by a day care procedure which help in diagnosis and treatment are done. Hysteroscopy,laparoscopy, adhesiolysis, etc. are done. These procedures help in treatment as well.
The male partner will also need to undergo tests like
- Semen analysis
- Ultrasound of the abdomen and pelvis
- Doppler venography, etc.
Routine tests for assessing the general health and specific hormonal tests must also be done for the male partner.
On finding the cause for infertility, the doctor will plan the treatment accordingly.
A specific plan of action:
- Polycystic ovarian syndrome- You may need birth control pills for 3 to 6 months. Metformin to control weight gain and sugar levels. Lifestyle modifications like healthy diet, exercise and ovarian drilling with laparoscopy.
- Endometriosis- Surgery to clear the cysts and help with conception. Laparoscopic procedures are by and large recommended .
- Fibroid Uterus- MYOMECTOMY for removal of fibroids can be done laparoscopically and can aid in conception.
- Progesterone and estrogen hormonal imbalance- supplements of specific hormone can be given
- Reduced ovulation-ovulation induction drugs every cycle and can be aided with Hcg injections after rupture of follicles.
- Cervical stenosis and vaginismus- treated with serial dilatation.
Male factor infertility is also treated in similar lines.
Once the cause is detected, options can include ovulation induction, artificial reproductive techniques like IUI, ICSI,and IVF.
The couple can choose the best method of treatment that suits their needs and can conceive in a short interval.
Infertility is no longer an unsolved mystery.