For couples who have recently discontinued contraception, the average monthly pregnancy rate approximates 20%. For a typical couple, this means that 50% conceive within 6months and another 30-40% conceivein the subsequent 6months. It becomes increasingly difficult to conceive spontaneously after 12 months of unsuccessful attempt. Therefore, infertility specialists recommend evaluation after 12 months of attempted conception. We also recommend evaluation after 6months inpatients over 35 due to concerns related to an age-related decline in fertility.
By definition, infertility is the inability to conceive after 12 months of unprotected intercourse. Primarily there are three tests necessary to determine the cause. Initially, the husband has a semen analysis to make certain that there is adequate number of sperm.
The second test is to document ovulation is occurring in the woman by an Endometrial Biopsy or having a simple hormone test, progesterone done one week prior to the next anticipated menses.
Provided both of these are normal, the next test involves an X-Ray. A hysterosalpingogram (HSG) is performed to document that the fallopian tubes are open & to make sure the uterine lining is compatible for embryo attachment. Dye is injected through the cervix into the uterine cavity.
Eventually the dye goes into the fallopian tubes & should flow out through the end of the tubes. This documents that sperm are able to get to the fallopian tubes where fertilization normally occurs & that the egg can be captured by the fallopian tube. These three tests are the cornerstones to infertility evaluation.
Besides the three basic tests – a Vaginal Sonographyis carried out to check the ovaries & the endometrial lining & any fibroids in uterus or cysts in the ovary are seen. Hormonal Analysis (Day 2 FSH, LH, Prolactin, TSH, E2) are also done. Laparoscopy & hysteroscopy are also donewhere indicated.
A Laparoscopy is particularly helpful in diagnosing & effectively treating endometriosis or pelvic adhesions(scar issue). The incisions for the procedures are small one fourth or half an inch & full recovery is often achievedin a day or two. Most importantly, in individuals with either of these conditions, a laparoscopy can dramatically improved the chances of conception.
Hysteroscopy is used to inspect the cavity of uterus via cervix using a fine telescope called a hysteroscope. Hysteroscopy is an investigation to assess the conditionof the endometrium( Lining of the uterus) before IVF
Avoid extra stress from overwork mental or physical. Both Smoking and alcohol can be harmful to eggs & sperm. Even exposure to passive smoking results in more problems with Infertility. Men can also stay away from heat emitting areas, wear loose under garments & avoid chemical exposure.
No, Infertile women who conceive after fertility treatment have a similar risk of miscarriage when compared to fertile couples. The overall risk of miscarriage is approximately 20% among the general population.
Women who experience bleeding in the first three months of pregnancy however, may be at increased risk of miscarriage. Despite this ,at least two- thirds of patients with bleeding will deliver normally.
While this is considered a ‘permanent’ form of contraception, patients do have the option of surgically reuniting the fallopian tubes through a process called a microscopic tubalreanastomosis. An alternative to the procedure would be In Vitro Fertilisation (IVF), where the eggs are fertilised outsidethe body with the resulting conception placed into the uterus.
The choice for an individual would require a consultation to consider all other fertility factors.