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When should you see a fertility specialist?
In such cases it is okay to feel anxious, but know that you aren't alone in the quest. Approximately, 8% to 10% of couples worldwide are suffering from fertility problems. The ability of conception right when they are physically and mentally ready is something almost every couple takes for granted. Most couples are even shocked to realize that the conception isn't occurring as planned.
What is infertility?
Infertility is a condition involving the inability to conceive after a year or longer of unprotected physical intimacies. Infertility is caused by various factors which may include issues with ovulation and other causes differing from person to person. Infertility may be an issue with unknown complexities. But, dozens of treatments can uplift the chances of conception and make a couple's journey to parenthood smoother than they think.
Your General Physician might recommend an early fertility evaluation under various circumstances. Or you or your partner should consult a relevant specialist in certain scenarios if:
- The male partner has a varicocele.
- The semen analysis reports of the male partner are abnormal.
- The genital pathology of the male partner is clinically worrisome.
- The male partner carries undescended testes.
- The male partner carries a medical history of surgeries like urogenital surgery.
- The female and/or male partner carries a history of Sexually Transmitted Diseases (STDs) or pelvic inflammatory disease.
- The female partner carries a medical history of examinations like abnormal pelvic examination.
- The female partner has a medical history of surgeries such as abdominal or pelvic surgery.
- The female partner carries medical conditions like Amenorrhoea or oligomenorrhoea.
- The female partner is more than 35 years of age and is unable to conceive even after 12 months of unprotected sexual intercourse.
- The female partner has Polycystic Ovary Syndrome (PCOS), Primary Ovarian Insufficiency (POI), Uterine Fibroids, Endometriosis and age above 40.
Are there any genetic predispositions causing infertility?
Yes. Genetic abnormalities are making it hard for a lady to become pregnant. A woman with certain genetic predispositions may face issues carrying the pregnancy to term. Rearrangement of genetic material or translocation is the two examples of genetic predispositions. There are more complicated occurrences in the wake of which a couple with genetic issues may wish to avoid inheriting certain illnesses to their future generation.
Preimplantation Genetic Diagnosis (PGD) combined with IVF present a range of benefits if a couple wishes to screen their heritable genetic abnormalities. PGD enables a couple to discover genetic details about their embryos before the couple proceeds for the implantation of the embryos. However, this type of treatment is helpful in certain clinical situations. An obstetrician or gynaecologist recommends this treatment based on various factors like medical history and current situation of the couple.
Clinical evaluation of infertility in men:
Smoking, alcohol consumption, obesity and old age are some of the common factors contributing to male factor infertility. However, these factors manifest as additional risk factors. Some of the main causes of infertility in men are antinuclear or autoimmune antibodies to sperm, chromosomal abnormalities, systemic diseases, history of infections, injury and anatomic variances.
Evaluation of male factor infertility begins with a medical history and the physical examination based on previous surgeries. The evaluation in the laboratory starts with a semen analysis. The analyst or laboratorian may ask the patient to abstain from ejaculation for 48-72 hours before the patient appears for the semen analysis. The sperm generation time spans mostly across 2 months. Therefore, the patient might have to wait for at least three months before going for the semen analysis again.
Clinical evaluation of infertility in women:
The clinical evaluation of infertility in women primarily covers the history of surgeries on reproductive organs. The analysis could look out for the factors such as tobacco consumption, alcohol consumption, occupational exposure, substance abuse, medication use, previous pregnancies and results, a previous usage of contraceptive medicines, time and frequency of sexual intercourse and menstrual history.
Below are the principles of care and advice for a healthy conception:
- All the experienced Reproductive Endocrinologists (RE) or fertility experts deploy a specialist team to treat a couple grappling infertility.
- The mainstay of the infertility treatment involves the couple, the sensitivity of the expert team towards the couple's clinical and emotional needs and patient information literature.
- Couples are advised to stop smoking or being around passive smokers.
- Couples are advised to stop or limit alcohol intake.
- Couples are requested to stay away from recreational drug use.
Are there any special instructions for men?
Men are advised by the andrologist/expert to avoid using tight clothes or underwear as they can cause testicular hyperthermia.
What is the key advice for the women willing to conceive and carry the pregnancy to term?
- Obstetricians might start with the analysis of Rubella. It may be followed by immunization as and if needed and the expert may chalk out further advice on pregnancy.
- The expert may seek to enhance the physical and emotional welfare before conception. It may range from proper BMI management to diabetic control.
- The advice may further include the prescriptions of 400 mcg Folic Acid before conception and up to 12 weeks of gestation.
- Most experts in Reproductive Healthcare may focus on extra precautions if the woman is on anticonvulsants or antidiabetic medications.
- The women on anticonvulsants or antidiabetic medications or those having a child with neural tube defect are prescribed 5 mg folic acid per day.
- The women with a body mass index greater than 29 kg/m2 are advised to lose weight.
The backbone of managing any illness including infertility is prevention. It tends to be difficult if not impossible to manage infertility caused by the congenital factors. The good news is unexplained infertility has treatments like intrauterine injections and IVF.
Advice to women planning to delay pregnancy for some reason
A women's fertility is at peak upto 30 to 35 years and thereafter it starts going downhill . In some women it may go down even at younger age . If for reason it is not possible to conceive earlier please see a Gynaec and get your ovarian reserve checked by AMH blood test and or sonography. If your ovarian reserve's is not so good the it is important to conceive In time or freeze your eggs to be used at later stage This is known as social egg freezing.
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