Ovulation Process

Hello to everybody. I am Dr Vandana Hegde. I am practising reproductive medicines in the Hegde Medical Centre from the last 10 years.

As I had explained the entire cycle. Two important things are there for the couple to plan pregnancy

One is the Ovulation time. When the ovulation happens, the female eggs that releases out. Its life is approximately 24 hours. And the male's sperm, once the ejaculation happens, its life span is 3-5 days upto the maximum of 7 days. So for couples to plan fertility naturally, it is important to conceive during the period of female ovulation time. And now ideally the female ovulation happen around the 14th day, it is best for the couple to plan intercourse atlreast 3days prior to the ovulation time. So, if they are ovualating on 14th day, so they can start planning the intercourse on around 10th day and upto a period of 16th day. Ideally, intercourse beyonf the period of Ovulation does not help the couples in conceiving. So, it is always better to plan before the ovulation time. Alternate intercourse is much better than having a daily intercourse during the ovulation time.

Now, coming to the Evaluation of Fertility.

When a couple comes to us when they are unable to conceive a child naturally even after one year. Then we do certain basic things as I have mentioned that it is very important to fid out that how the egg is finally to form an embryo. Yu need egg from the female partner and sperm from the male partner which are diffused internally. So what is important is the normal sperm and a normal tube in the uterus. So we do assessment in that order. So ideally we get the male partner 7 testing time to see the sperm count, the sperm motality and the sperm morphology. The sperms should be genetically fit to give a healthy child. So this is assist by doing semen analysis where the male partner will give the semen sample for about 3-4 days. And this semen sample is examined under the micrscope where the assessment is done on the basis of count, mortality and Morphology. If the semen criteria is normal then we evaluate the female partner.

Now the female partner, if she has regular cycle, we assume that the ovulation is happening normally. But there are certain girls who has irregular periods. Some have early periods and sme have quite delayed cycle. Now, what is the main issue here is Ovulation. Probably they are not ovulating around the 14th day. But there are 2 disfunctions.

• One is anovulatory, there are certain girls whoch are not ovulating at all. There is no egg formation, there is no ovulation. Now this criteria of girls manage in a different way.
• Now there are other type of girls, who are probably having a shorter cycle, they are ovulating very early.

Now, we need to differentiate between these two types. The whole management depends upon correcting these abnormality.

Now, coming to the other part of the tubes. Once the sperm is there and the egg is there, one should have patent fallopian tube for them to meet. So, ideally what we do is, when the couple comes to us, we evaluate the spem parameters, the female ovum parameters and then we do a time intercourse for them.

We start basic tracking of the follicle growth. The best thing is the follicle is seen in the ultrasound reports. So the basic ultrasound is done initially to diagnose. If the female uterus, the ovaries are normal then they should not be ahving any fiberoids and ovarian cyst. So Fiberoids are basically tumours in the uterus which can prevent implantation of the embryo and there may be some ovarian cyst which may be preventing normal ovulation and there are other cyst which require surgical removal. We do basic ultrasound scan to roll out all other major thing and then proceed to Folliculat tracking.

Follicular tracking is seen on the scan. Though the egg can not be seen on the scan so follicles can be seen. So, when the couple ccomes to us in initial part, we track the follicle growth and this is the time, the female is ovulating and we give them the dates to meet. This is done on the monthly basis for atleast 2-3 cycles. Now, inspite of tracking natural cycle follicular growth and at the time intercourse if the couple is not able to conceive then we go for other evaluations. Like, is the tube open? Is the uterine cavity normal?

So there are tests to check if the fallopian tubes are open. Now it is very important for the tube to open because all the activities are happening inside the tube. so there is a test called "Hysterosalpingographie", where the die is pushed through the uterine end. This die is travelling around the cavity and coming into the tubes and then comes out.

All this is recorded in teh X-ay film. This film records this passage of the dia nd we find out the tubal blocks. If the tube is blocked then the egg and the sperm do not meet. So there comes fertility issues.

We do other assessments also like Diagnosis hysteroscopy and laparoscopy for infertility. So this is a surgical process which we do when couples are not able to conceive even after 6 months of fertility planning.

There are small tumours in the cavity which can prevent embryo from Implanting and these are absolutely necessary to be removed if the couple is not conceiving with these.

And the other things we diagnose is the laparoscopy in which we put the camera inside to record if te tube and ovary are in normal position and HYsteroscopy is a process done under the anesthesia only. Then we proceed with further treatment with fertility planning.