‘It is possible to figure out the cause for infertility in about a month’

‘So, when are you planning to have a baby?’ This is the commonest question most newly married couples in India are asked - sometimes even as soon as they have returned from the honeymoon! There is

By: Dr Aniruddha Malpani | | Updated: October 8, 2014 8:14 pm

Tags: Assisted Reproductive Technology Ovulation

‘So, when are you planning to have a baby?’ This is the commonest question most newly married couples in India are asked – sometimes even as soon as they have returned from the honeymoon! There is a lot of pressure on couples to have a baby, especially in traditional families, where the wife’s role is still seen to be one of perpetuating the family name by producing heirs. Couples are under a lot of stress as they ‘try’ for a baby but are unsuccessful. In such circumstances, a lot of questions haunt the couple – how long should they try before visiting a doctor? Are they ‘infertile’? What could be causing the infertility? In this post, Dr Aniruddha Malpani, renowned infertility specialist, explains the basics you should know in detail. Also Read - ART helping millions of infertile couples become parents: How does it work?

When you try for a baby, do remember that the chances of pregnancy for a couple in a given month will depend upon many factors like: Also Read - Night work shifts can increase early menopause by nine percent, reveals study

The age of the woman. At the biologic clock ticks on, the number of eggs and their quality starts decreasing.
Frequency of intercourse. While there is no ‘normal’ frequency for sex, the ‘optimal’ frequency of intercourse if you are trying to get pregnant is about 3 times a week in the fertile period. Simply stated, the more sex the better! Couples who have intercourse less frequently, have a diminished chance of conceiving.
‘Trying time’ – that is, how long the couple have been trying to get pregnant. This is an important concept. The longer a couple has been trying to conceive without success, the lesser their chances of getting pregnant without medical help.
The presence of fertility problems.

Understanding where the problem lies Also Read - Woman, want to get pregnant? Reduce your stress levels

In order to understand why pregnancy doesn’t occur, we need to examine only the four critical areas which are needed to make a baby – eggs, sperm, fallopian tubes, and the uterus. The tests, which often seem endless, will actually fall into examining one of these four areas. In 40% of cases, the problem will be with the male, in 40% with the female, and in 10% both partners will have a problem. In some cases, about 10%, no cause can be identified (unexplained infertility) even after exhaustive testing.

Before starting with tests, the doctor takes a detailed medical history from the couple, and also performs a physical examination for both of them, to determine if this can provide clues as to the cause of the problem. The doctor will need to find out details about your menstrual cycle, as well as your sexual habits and past history of surgery or illness, so you should be prepared to answer these questions. Many clinics give patients a form to fill out, so that they can provide all this information. A physical examination can also provide the doctor with useful information, and he will look specifically for important clinical findings such as abnormal hair growth, excessively oily skin, or the presence of a milky discharge from the breast.

Tests for diagnosing the cause for infertility:

These specialized tests constitute the infertility workup and they can be completed efficiently in one month. Timing the procedures properly during the menstrual cycle is important and we have found the following strategy useful in our practice.

Remember that the couple must be seen together and the first test which should be done is a semen analysis. Sadly, in our country, sometimes the wife will have undergone innumerable tests (sometimes repeatedly!) and the husband’s semen analysis (where the problem lies) has not been done even once. The semen analysis to check the husband’s sperm count and motility can be done can be done on Day 3-4 of the wife’s menstrual cycle, after requesting him to abstain from ejaculation for at least 3 days .

The wife then undergoes some hormonal tests for measuring the levels of her four key reproductive hormones – prolactin, LH (luteining hormone), FSH ( follicle stimulating hormone), TSH ( thyroid stimulating hormone). Since these levels vary during the menstrual cycle, they should be done between Day 3-5 of the cycle.

Then doctors will do a hysterosalpingogram (an X-ray of the uterus and tubes) for the woman after the menstrual bleeding has stopped – between Day 5-7, to confirm that her uterus and tubes are normal. The couple is then called for a consultation on Day 9 with all these reports and the results of the tests are reviewed. These three basic tests allow us to check whether the eggs, sperm, uterus and tubes are normal.

At times, some more tests may be required (though these tests are rarely done in my own practice). They include ultrasound scans for ovulation monitoring between Day 11-16 and the scan results can be used for timing the PCT (postcoital test) as well, during which time the cervical mucus is assessed. Serum progesterone level can be measured on Day 21, about 7 days after ovulation, and this provides information about the quality of ovulation. Some doctors also perform a laparoscopy in the same month (Day 20-25) and combine it with an endometrial biopsy (taking a small sample from the wall of the uterus) if desired.

With this strategy, it is possible to figure out the cause for infertility in about a month.

Unfortunately, it is very common to find that tests are done on a piecemeal basis – or sometimes, not done at all. Often treatment is started before coming to a diagnosis. Conversely, some doctors take so long to do the tests, that patients get fed up – after all, they want treatment!

The workup should not stop when a problem is discovered – it is still important to complete the testing, since it is possible that infertile couples may have multiple problems. Many diseases, such as pelvic inflammatory disease ( PID) which can cause the tubes to get blocked, can be ‘silent’, so that the patient may have absolutely no signs or symptoms.

A single test abnormality does not necessarily mean that a problem exists and the test may need to be repeated, to figure out if it is a persistent problem.

Sometimes it can be difficult for patients to come to terms with the fact that there is a major problem which presents a significant hurdle to getting pregnant. The truth can be bitter, but it’s far better to face up to it and deal with it, rather than live in a fool’s paradise! With today’s advanced reproductive technology, we can always find a solution, no matter what the problem – but remember that unless you can intelligently identify the problem, you cannot find a solution !

It is only after the workup has been completed, that a treatment plan can be formulated – and you will now need to make decisions about treatment options.

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Published : October 21, 2013 11:12 am | Updated:October 8, 2014 8:14 pm