Q1. For how long a period of time should a couple try to conceive before seeking advice from a specialist?
Couples who have recently stopped contraception, the average pregnancy rate per month is about 20%. In case of a typical couple, it actually means that 50% get pregnant within the first six months and another 30-40% conceive in the following 6 months. It becomes difficult to conceive after a year of unsuccessful attempts and infertility specialists suggest assessment after 12 months of attempted conception. We also advise assessment after 6 months in patients who are above the age of 35 owing to an age-related decline in fertility that happens with most people.
Q2. How to tell if I am infertile & how can I find out the cause of my infertility?
Infertility is not being able to conceive even after a year of unprotected intercourse. Mainly, there are three types of tests which are required to determine the cause. Firstly, semen analysis of the husband is done to ensure that there is adequate number of sperms being produced. The second test is done to see whether ovulation is happening in the woman or not with the help of an endometrial biopsy or having a simple hormone test. The progesterone test is done one week prior to the next predictable menses.
If both the tests are normal, then the next test is an x-ray. A hysterosalpingogram (HSG) is done to see if the fallopian tubes are open and in order to make sure that the uterine lining is well-matched for embryo attachment. A dye is injected through the cervix into the uterine cavity. This test tells that the sperms are able to get to the fallopian tubes where fertilization takes place and the egg can be captured by the fallopian tube. These three tests are the basis to infertility evaluation.
Q3. What other diagnostic tests can be performed?
Apart from the three basic tests – a Vaginal Sonography can be done to check the ovaries, the endometrial lining and to see if there are any fibroids in the uterus or cysts in the ovary. Hormonal analysis is also done and laparoscopy and hysteroscopy are done as and when required.
Q4. What role does Endoscopy play in Infertility?
Laparoscopy is specifically helpful in finding out and efficiently treating endometriosis or pelvic adhesions (scar issue). The incisions done are quite small and patient can recover fully in a day or two. Most importantly, in individuals with either of these conditions, laparoscopy can be very helpful and can tremendously increase the chances of conception.
Hysteroscopy is done to inspect the cavity of the uterus via the cervix with the help of a fine telescope called a hysteroscope. Hysteroscopy is basically a study to evaluate the condition of the Endometrium ( Lining of the uterus) before IVF.
Q5. Any measures to be taken in order to improve the chances of a thriving pregnancy?
Avoid taking extra pressure from overwork both mental and physical. Smoking and drinking can also be harmful to eggs & sperm and even passive smoking results in Infertility related complications. Men should wear loose under garments, avoid chemical exposure and should stay away from heat emitting areas.
Q6. Are miscarriages common following Infertility Treatment?
No, infertile women who get pregnant after fertility treatment have a similar chance of miscarriage as fertile couples. The overall risk is just about 20% among the general population. Women who face bleeding in the first trimester of pregnancy are at improved risk of miscarriage. Despite this difficulty, at least two- thirds of patients with blood loss deliver normally.
Q7. Is it possible to get pregnant if I’ve had a tubal sterilization?
Although it is a permanent form of contraception, patients also have the option of surgically joining fallopian tubes through a procedure called a Microscopic Tubalreanastomosis. Another option would be In Vitro Fertilization (IVF), where the eggs are fertilized outside the body with the resultant embryo placed into the uterus.