PRIMARY COUPLE EVALUATION

  • ABOUT INFERTILITY-
  • Infertility is a significant social and medical problem affecting couples worldwide.
  • Infertility is defined as failure to achieve pregnancy after 12 months of unprotected intercourse.
  • In India, approximately 15-20% of couples are infertile.
  • The female factor is responsible for 40% of cases, the male factor for 40%, and combined for 20% of infertility.
  • Fertility tests are the best way to know about your infertility status and can help you find the cause of it.
  • TYPES OF INFERTILITY:

Primary Infertility: A couple that has never conceived.

Secondary Infertility: Infertility that occurs after previous pregnancy regardless of the outcome.

  • WHEN SHOULD A COUPLE TEST?
  • If under the age of 35 and trying regularly for 12 months.
  • If above the age of 35 years and trying regularly for 6 months.
  • WHEN SHOULD A COUPLE SEE A FERTILITY SPECIALIST BEFORE ?
  • Women over age of 35yrs
  • History of oligomenorrhea or amenorrhea
  • Thyroid problems
  • PCOS
  • Erectile or ejaculatory dysfunction
  • Irregular periods
  • Repeated Miscarriage
  • Pelvic Inflammatory Disease
  • Past Ovarian/Uterine surgery
  • Family history of early menopause
  • WHAT A COUPLE SHOULD EXCEPT DURING FIRST EVALUATION?
  • Infertility evaluation involves male partner and female partner evaluation.

In females,

  • Detailed history is taken -Age, Marriage duration, Type of infertility, Consanguinity (Marriage amongst 1st degree relative)
  • Menstrual history- Regularity , flow , pain and duration of bleeding are assessed.
  • A normal ovulating woman would bleed every 28-30 days without any pain and heavy bleeding.
  • Complaints- Menstrual and other complaints may point towards the cause of infertility.
  • Past Medical/ Surgical History
  • Past treatment history
  • Vitals- Height, weight, BMI, Pulse, Blood pressure

In males,

  • Any history of medical or surgical illness.

For Both,

  • Sexual History-Frequency of intercourse.
  • Personal history-History of Alcohol, smoking, cigarette etc
  • Family history- History of early menopause, diabetes, Hypertension, fibroids.
  • PRIMARY TESTS NEEDED
  • IN MALE EVALUATION -
  • Semen Analysis

It is the most common test performed. 

The male partner is asked to give semen sample which will be assessed by an andrologist for volume, count, motility, morphology and other parameters. Genital examination and urologist opinion may be advised on a case to case basis.

  • Others like Scrotal Ultrasound, Sperm DNA Fragmentation may be required case to case.
  • Blood test – CBC, Sugars(FBS/PPBS), urine routine, Viral markers -TSH, PRL,FSH, LH, S.Testosterone (If required).
  • IN FEMALE EVALUATION -
  • Genital examination
  • Pelvic Ultrasound is performed to assess the uterus and ovaries.

     Uterus is assessed for the endometrial lining, blood flow and any other abnormalities like fibroid, polyp , adenomyosis etc

   Ovaries are assessed for the follicle count, which gives an estimate of the ovarian reserve  and any other abnormality like ovarian cysts or endometriosis.

  • Blood test:

            Basic-  CBC, FBS, PPBS, urine routine, viral markers

            Special- TSH , PRL, AMH

            Others-S.FSH, S.LH, S. Estradiol (If required)

 After that, the couple is explained about normal fertility and advice given based on the reports.

Remember that your doctor will plan tests based on you and your partner’s situation and medical history. Thus, you and your partner may not require all of the tests, and they may be done in a different order depending from doctor to doctor.

  • TREATMENT OPTIONS FOR THE COUPLE

After detailed evaluation, depending on the cause, following treatment options are available

  • 1) Planned relation
  • Natural cycle monitoring followed by planned relationship. 
  • With Ultrasonography, the growth of the follicle and endometrial response is monitored. 
  • Ovulation is confirmed. 
  • Couple is asked to have relationship around the ovulatory period.
  • 2) Ovulation Induction
  • Certain tablets may be given to form a good single follicle and its growth monitored on USG.
  • Couple will be asked to have relationship around ovulatory period.
  • 3) Ovarian hyperstimulation.
  • Certain tablets and injections may be given to form more than one follicle and their growth monitored with USG
  • When follicles would be optimally formed, injection will be given to induce ovulation
  • Couple will be asked to have relationship around ovulation period or IUI may be done.
  • 4)Tubal testing
  • For natural conception, tubal patency is very important.
  • It may need evaluation with Sonosalphingography , Hysterosalphingography or Hysterolaparoscopy.
  • In Sonosalphingography, tubal patency is assessed through ultrasonography.
  • In Hysterosalphingography, tubal patency is assessed through X-Ray or C-ARM.
  • In Hysterolaparoscopy, tubal patency is assessed through laparoscopy. It the gold standard for evaluation. It helps in assessing as well as correcting the blocked tubes at the same time.
  • 5) Intrauterine Insemination (IUI)
  • Intra-uterine insemination (IUI) also known as Artificial Insemination is a process in which the washed/processed semen is placed into the uterine cavity with the help of a catheter in and around the time of ovulation (release of egg from the ovary).
  • It is usually accompanied with ovulation induction or hyperstimulation.
  • 6) ART (Artificial Reproductive Technology)
  • In couples who can’t conceive naturally due to blocked or damaged tubes, poor ovarian reserve, low sperm count or motility, one can conceive through Test tube baby treatment.
  • In this using women’s egg and husband’s sperm, embryo is formed in the specialized laboratory and then transferred back to the uterus at appropriate time.
  • ART involves IVF, ICSI, Donor programme, Freezing of eggs, sperms and embryos.
  • 7) Diagnostic and Corrective surgeries
  • Fertility Enhancing Hysteroscopic as well as Laparoscopic surgeries may be required to diagnose as well as correct any lesions like fibroids, polyps, ashermann’s, endometriosis, septum, uterine anomalies etc

BOOK AN APPOINTMENT NOW to increase your chance of getting pregnant.

We at INFINITY FERTILITY CENTRE provide the most affordable , low cost & high success rate customised treatment in Thane.