Infertility is defined as a couple’s inability to conceive after one year of regular unprotected intercourse.
Everybody’s fertility journey is different. Women who are more than 35 years should consult an expert after 6 months of contraceptive free sexual intercourse when it has not resulted in pregnancy. This difference in the time limit is owing to the declining egg quality with increasing age. Beyond this, it is encouraged that couples seek some basic assessment and investigations. In India, infertility can be attributed to factors in men in 35% , and an equal percentage of women, while, both partners face the problem in 20-30% of cases, in rest infertility is unexplained. Causes of infertility in women are tubal blockage and/or peritoneal factors, irregular or abnormal ovulation or endometriosis. Causes in men are poor sperm quality or quantity.You may have already had some tests with your GP or referring doctor, to review. If you haven’t had any tests, we can help. Both the partners in an infertile couple must undergo a set of advance comprehensive tests before the commencement of any treatment. Understanding the root cause of fertility issues early provides a greater chance of being able to devise optimum women and male infertility treatment via thorough assessment & correct diagnosis. This ultimately helps the couple conceive. They are essential to determine the causes of infertility, to know whether the couples are diagnosed with any other ailment and which technique would be most suitable for a particular couple. They also form a part of a quick Fertility Check for the couples who are not actively trying for pregnancy or seeking a fertility treatment to estimate the length of time they can delay it upto.
We are a clinic offering infertility treatment in Mumbai. The first step to having fertility treatment is to come for the Initial Consultation and an Advanced Ultrasound Scan with our expert clinicians.
Preliminary investigations at Anmol Fertility & IVF Centre
Preconception screening : For woman, this includes rubella, HIV, hepatitis B and C and syphilis serology. Discussion about healthy weight management and nutrition, folic acid supplementation may also be salient. For the male, infectious diseases screening is also an important consideration (hepatitis B and C and HIV, VDRL)
Male : Semen analysis ( WHO 2010 reference)
Female: Advanced trans-vaginal ultrasound to evaluate ovarian reserve ( Antral follicular count)& uterus condition& blood flows. To assess for anatomical causes of female infertility if any, including endometriomas, ovarian cysts, hydrosalpinges, leiomyomas and endometrial polyps, Blood workup( TSH, Prolactin, fasting and post-lunch blood sugars)
Advanced investigations ( Depending on the case)
Male: Hormone blood tests ( FSH, Testosterone, TSH), Genetic testing
Female: Detection of ovarian function by hormonal assay (early follicular FSH and LH levels, mid-luteal progesterone, S. Antimullerian Hormone AMH ), Evaluation of tubal patency by hysterosalpingography (HSG/ laparoscopy), Hysteroscopy, Genetic testing.
Infertility affects one in six couples globally and the rate is increasing. In India, only 20 % seek treatment from specialists & it is perceived as a social problem in our country, with various medical manifestations. The cause of infertility could be in either of the partners (Male factor-35%, Female factor-40%) or in 10-15% both partners may be infertile or sub-fertile. sometimes each could be individually fertile but as a couple may need assistance to achieve pregnancy the causes could be immunological or genetic, this is called Combined infertility. While in about 10%, the fertility evaluation shows no abnormality, these patients are likely to have problems which are not diagnosed by current available investigations, this is termed unexplained infertility.
However, advances in medical science have made it possible for infertile couples to experience the joys of parenthood. Since the birth of Louise Brown on 25th July 1978, over 6 million test tube babies have been born, lighting up their parents’ lives. Some patients spontaneously achieve pregnancy but others at some stage experience difficulty in achieving conception and these patients need some kind of assistance in getting pregnant. It is estimated that out 100 couple with female partner’s age less than 35 years, approx 80-85% will achieve pregnancy within the first year of unprotected intercourse, 90% will conceive within 18 months and about 95% will conceive within two years. The remaining 5% rarely achieve pregnancy without some form of assistance. In some couples the fertility is impaired to some extent but not completely, these patients may conceive in 3rd year or subsequently without any assistance as there is a delay these patients are called subfertile.
How long should we try before we see a doctor?
Experts often advise you not to be concerned unless you have been trying to conceive for at least one year, unless you do not menstruate regularly. Cumulative probability of pregnancy in general population: 84% 1st year, 92% 2nd year and 93% 3rd year, However, if you are over 30 years old, have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if your partner has a known low sperm count, it is often recommended by doctors that you may want to seek help sooner. Many couples have a hard time admitting that there may be an infertility problem. When these hopes are dashed month after month, a woman often consults her regular Ob/Gyn or GP before visiting a fertility specialist.
Infertility – what are the main causes?
PCOS?
Polycystic ovary syndrome (PCOS) is an ovulation disorder. PCOS affects around 4-6% of all women in the reproductive age. We do not exactly know what causes the disease, but genetic factors and environmental factors may contribute to the disease. The main symptoms are irregular menstrual cycles, hirsutism, acne and obesity. To increase the chances of pregnancy, treatment is focused on regulating ovulation along with weight optimization.
Causes of damaged fallopian tubes
Infections caused by sexually transmitted diseases such as chlamydia and gonorrhoea can lead to damages of the tubes. Tuberculosis is a vital player in the Indian setting. Other causes include septic abortion, ruptured appendix, tubal surgery or tubal pregnancy.
Endometriosis
Endometriosis is the occurrence of endometrial tissue outside the uterus. It is estimated that 3-10% of women in the reproductive age have endometriosis. The major symptoms of Endometriosis are abdominal pain, especially during menstruation and during coitus. While there are many theories to the causes, we still do not know exactly what causes endometriosis or how it affects fertility.
Infertility with advanced age.
Infertility among women increases with age. Below the age of 31 the pregnancy rate over one year is 74%. This decreases to 62% at ages 31 to 35 and to 54% for women older than 35. It is very difficult to predict the chance of pregnancy for an individual, but research shows that fertility decreases with age due to the declining quantity and quality of the woman’s eggs.
Recurrent miscarriages.
The incidence of pregnancy loss among all women is about 15%. Recurrent miscarriage affects 1% of all women. Approximately 70% of all early spontaneous miscarriages are associated with fatal chromosomal abnormalities. In most cases, the parents are chromosomally normal and a fatal chromosomal abnormality is a random event.