Infertility

Hello friends,

I am Dr. Mrs Kaushal Kadam, medical director of Corion fertility clinic in Andheri, Mumbai. To begin with let's start with what is infertility exactly. Infertility, as we say, is non-conception for a period of more than 2 years with unprotected intercourse. So, patients who have had tried for 2 years without using any protection and if not being successful in getting a baby are considered to be subfertile or infertile. These are the patients who should really refer to a fertility physician and get themselves checked. So what is it that you will first encounter when you meet a fertility physician? When you first meet the physician they will make you undergo a few tests. These are basic infertility tests. For the women, she will have to undergo a few hormonal tests which will include checking your thyroid levels, serum prolactin, serum AMH and further tests just to know that your body is fine metabolically. For the male patient, he will need to undergo a semen analysis maybe a semen culture and a few tests on the semen sample to know that the semen sample is fine and is normal. Going further into what are these hormonal tests?

Ok, so serum thyroid and serum TSH and serum prolactin. Thyroid is a very common issue that we see in quite a few of our patients and if corrected this can just result in pregnancy at home. This is so often overlooked and so if we find any kind of problems be it serum TSH which is low or serum TSH which is high can cause a problem and can lead to infertility and a just correction of this by taking medication will solve the problem and you will find yourself pregnant. Serum prolactin is another hormone that is present in our body. Any kind of stress will cause the levels of this hormone to go high and this interferes with the implantation and does not result in a pregnancy. So, very important to ensure that we keep the serum prolactin levels in check. Coming to the most important hormone that is serum AMH that is Anti-Mullerian hormone. This is one hormone that you will often find your gynaecologist as well as your fertility physician talking to you about and laying a lot of stress on it. This hormone is a hormone that tells us about your ovarian reserve.

This hormone is one hormone that tells us the capacity of your ovaries to form eggs. Mind you, all of us, all women have a fertility age or fertility starts declining for these patients beyond 38 years of age. Why exactly does this happen? All of us are born with millions of eggs but once we reach puberty and we start ovulating each month we lose quite a few of our eggs resulting in a decrease in the number of eggs that are finally left and that is why patients who have a low ovarian reserve are told to plan a pregnancy as soon as possible. So, one must check for this hormonal level to know what is the time period that is left for them to start with their motherhood. As far as semen analysis is concerned WHO now has come out with recent criteria where they say that even 15 million per ml of sperm count is considered to be normal, 40% of motility is considered normal and abnormal sperms of up to 96% is absolutely normal. So, one should not panic when they see a high number of abnormal sperms but again you must refer to your fertility physician because he or she is the person who is going to guide you to at least shorten your trying period and try to get your pregnancy at the earliest. Having done these tests let's move on to the next test that your fertility physician may ask you to undergo.

This is usually a test to check whether your tubes are patent or not. It is very important because mind you conception takes place in the tube and for that reason, the tubes need to be open. If those patients are having their tubes which are closed because of various problems like tuberculosis in childhood or any other infection, sometimes surgery which may cause a blocked tube; then these are the patients who may require a work up and may not be possible for them to get pregnant at home. Again, God has blessed us with two tubes so even if you have one tube that is open that is enough for you to complete your family. So, tube test very typically they will ask you to undergo an HSG or a histosalpingogram. This is an invasive test and nowadays we are not doing this test and in fact, have come up with sonosalpingogram. This is less invasive and much more patient friendly so you can always ask your doctor or request your doctor to prefer this test instead of the HSG.

SSG or sono saline sonosalpingogram is a test wherein they pass a catheter through your uterus passing some saline and then on ultrasound check if there is spillage of the saline outside the uterus and the ovaries. If they see this fluid then we know that your tubes are patent and this should be enough for us to plan further management. HSG, on the other hand, is painful, it involves the invasive technique of undergoing an x-ray which is something that we do not prefer these days and it is very painful. So, having done these tests your doctor will then have a look and tell us what is the further workup that needs to be done. Although we say that infertility work up should begin after 2 years of trying at home, there are a few patients whom we will say that need a workup much prior to this. Who are these patients? These are the ones who have a prior history of tuberculosis, patients who have married at a much later age like say they have married at around 37,38 and now they need to plan a pregnancy as soon as possible. Patients who have irregular periods, patients who have very painful periods, of course, need a workup and thus these patients should definitely seek the help of a fertility physician much earlier than two years.

Thanks!