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Infertility is the inability to conceive describe trying properly for at least one year.
INFERTILITY = NO PREGNANCY AFTER 1 YEAR
We have to understand that treating infertility involves identifying problems in the husband and wife. In our society it is mostly or always the female partner who goes for medical check-up in case of inability to conceive only where the husband’s problem is detected. Only in few cases the husband comes forward to get himself tested for sperm problems and in all other couples the wife is tested first.
We have to understand that treating infertility involves identifying problems in the husband and wife. In our society it is mostly or always the female partner who goes for medical check-up in case of inability to conceive only where the husband’s problem is detected. Only in few cases the husband comes forward to get himself tested for sperm problems and in all other couples the wife is tested first.
Check both male and female partners.
Treatment of infertility includes simultaneous treatment of both husband and wife.
Husband’s sperm problems or problems with ejaculation of semen/ getting an adequate erection to be able to deliver semen inside the wife’s birth passage, are evaluated by the Andrologist.
Female partner evaluation is performed by the RMU
Basic menstrual history and clinical examination
Body mass index/ hair pattern/ fat pattern
Scan of ovaries and uterus
Menstrual history including the regularity of cycles, amount of flow, pain during cycles, recent change in pattern of cycles, missed periods, medications, recent weight gain, stress, food habits and lifestyle are elicited. Clinical examination of the reproductive tract and a basic transvaginal ultrasound of the pelvis to look for ovarian volume, presence of polycystic ovaries, uterine cavity assessment endometrial thickness is the first set of tests done for women.
Hormone profile
Thyroid hormone test
Prolactin (select women)
Anti-mullerian hormone
Follicular monitoring
Hysterosalpingogram
The second tier of investigations include female hormone profile (preferably on second day of cycles), additional blood tests like thyroid hormone levels and prolactin in some women. Ultrasound (Transvaginal) guided follicular monitoring (from second day of cycles), anti mullerian hormone and hysterosalpingogram are done in select patients.
Low sperm count
Sperm passage infections
Varicocele
Azoospermia
Low hormones
Diagnostic laparoscopy
Hysteroscopy
Diagnostic laparoscopy (with tubal patency assessment) is done for women with suspected pelvic endometriosis or blockage in the tubes and associated polycystic ovaries or uterine abnormalities. It can be combined with diagnostic (± therapeutic) hysteroscopy.
Egg reserve and egg passage
Prior miscarriages/ abortions/ treatment/ married years
Age of wife and husband
Sperm quality
Once all the investigations of husband and wife are completed, treatment is planned based on the age of the female partner, years of married life, previous treatment failures or miscarriages, egg reserve and sperm quality.
Intrauterine insemination
Assisted natural conception
Test tube baby technique - IVF and ICSI
The couples have options like assisted natural conception, assisted reproduction techniques like intra uterine insemination, test tube baby technique which includes IVF and ICSI. After successful embryo transfer the women would be expected to be on hormone therapy till the placenta takes over.
The final myth that babies born out of assisted reproduction will be genetically defective is wrong. Though there is a slightly increased chance of congenital abnormalities, we perform scans, blood tests and special diagnostic procedures like PGS in in specialised circumstances and in women with recurrent pregnancy losses, as such the babies born out of assisted reproduction are normal.
Repeated miscarriages is a distressing problem. Both female and male partners might be completely normal but still the couple will be facing repeated miscarriages. We do some investigations, assess the uterine cavity and endometrial receptivity assay to see if there is a problem with the embryo getting attached to the uterine wall. There are also some medications help in successful implantation of the embryo to the uterine cavity.
In case you are suffering from infertility visit the andrologist and the reproductive medicine expert to get yourself assessed and soon successfully carrying your baby inside.
REPRODUCTIVE MEDICINE & SURGERY
CONSULTANT
REPRODUCTIVE MEDICINE & SURGERY
SR.CONSULTANT