Maple Clinic

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WHAT IS INFERTILITY?

Inability to conceive( get pregnant ) after one year of unprotected intercourse is clinically defined as infertility. It warrants evaluation of the couple by the fertility specialist on priority basis .
Here age is an important consideration . If age of the wife is >35 years or age of the husband is >40 years,then early evaluation and treatment is warranted ,even after 6 months of trying for a pregnancy.

WHO IS RESPONSIBLE FOR INFERTILITY ?

Male (husband) – 30 %
Female (wife) – 40 %
Both ( Husband & Wife )– 20%
Unexplained ( All tests are normal ) – 10%

WHAT ARE COMMON CAUSES OF INFERTILITY ?

Ovulatory Dysfunction
Fallopian Tubes blockages
Polycystic ovarian disease
Endometriosis

Sperm defects – counts and motility

WHAT ARE THE PROGNOSTIC MARKERS IN INFERTILTY

Age – Increased age of wife or husband is associated with poor prognosis. Therefore such couples should seek treatment early to get maximum success rates .

Duration of infertility – Longer the duration of infertility , poorer is the prognosis. So these couples should not waste much of their time with conservative management .They can opt for assisted reproduction techniques early( IVF/ ICSI )

Obesity – Patients with higher BMI ( Body mass index ) have been associated with poor fertility potential . It is therefore advisable to optimise body weight, this can definitely improve the egg and sperm quality .

Medical disorders – Underlying medical disorders like Diabetes, Hypertension , Thyroid dysfunction, Hormonal disorders , Chronic infections and Deficiencies of vitamins etc should be well under control before starting with fertility treatment .

WHAT TESTS ARE DONE TO EVALUATE INFERTILITY

Couple has to undergo different kinds of tests and diagnostic procedures to evaluate their case and find the reason for infertility. This is often time consuming and requires multiple visits at different phases of your menstrual cycle. The couple should be patient and cooperative in this entire process.

Routine screening blood tests – Blood group , Blood counts , HIV & Hepatitis screening, Liver & kidney function test, Hemoglobinopathies screening, Rubella immune status, Vitamin D3 and B12 levels etc .

Semen Analysis of the husband– provides information about sperms in detail like counts , motility and morphology.The male factor infertility can be easily diagnosed by this simple test.
Ultrasound pelvis ( TVS ) – By doing a transvaginal sonography ,one can diagnose abnormalities in uterus and ovaries like ovarian cysts, PCOD, endometrioma, fibroid and polyps. TVS is used for follicular monitoring in ovulation study. It is also an essential tool during treatment cycles in assisted reproduction.

Hormonal blood tests – Doing blood levels of certain reproductive hormones is an important part of fertility evaluation. Some of the common blood tests are – FSH, LH, Prolactin , TSH, Testosterone, Estradiol, Progesterone . They may be recommended at different phases of your menstrual cycle . AMH ( Anti Mullerian Hormone ) is an important marker of ovarian reserve in females.

HysteroSalphingoGraphy ( HSG ) – It is a procedure to check for patency of both fallopian tubes . It is done by your gynaecologist where she will instill a radioopaque dye with the help of a special cannula into the uterus .By taking X Ray films ,the course of dye through both fallopian tubes followed by its spill into pelvis can be visualised. It is a painful procedure so you can ask for pain relief options from your gynaecologist.

Laparoscopy – In few of the infertility cases , one needs to undergo a major surgical procedure called Laparoscopy ( i.e. putting endoscope into your abdomen to directly visualise the pelvis). The common indications for doing it are-
Diagnostic purpose in unexplained infertility
To remove fibroids and ovarian cysts
To confirm that tubes are healthy and patent
To clip the dilated unhealthy tubes before IVF
For surgical management of endometriosis, PCOD, Adhesions.

Hysteroscopy – It is an operative procedure to visualize the uterine cavity by a special endoscope .It can be used for various purpose – For evaluating uterine cavity before IVF cycle To diagnose and correct the septum inside uterus To diagnose and clear the adhesions inside uterine cavity To see signs of genital tuberculosis To diagnose and remove polyps and fibroids inside the uterus
Special tests– May be recommended sometimes in atypical cases Endometrial sampling – for genital tuberculosis and biopsy Culture and sensitivity- semen , urine and endometrium Antiphospholipid syndrome screening Karyotyping of couple Pre Implantation genetic testing( PGT A) Analysis of all the tests done will help in making the treatment plan for the infertile couple .