Steps for infertility treatment

Dr. Anannya Chakraborty
INFERTILITY & IVF SPECIALIST

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Parenthood is an inestimable blessing to a couple. Around 48 million couples globally are devoid of this blessing. Inability to have a baby even after appropriately trying for one year is regarded as infertility. The cause of infertility may be related to either or both the partners or unexplained.

Evaluation

A detailed history and examination of the couple is indispensable in the diagnosis and management. 

Evaluation of the male partner begins with looking for features of hormonal deficiency-decreased libido; sexual disturbances; decreased facial and body hair, etc, history of genital infection or trauma, medical or surgical disease, history of drug intake, followed by a thorough genital examination by an expert. Blood analysis for general health and hormonal profile namely TSH, Prolactin, FSH, and testosterone aid in the preliminary diagnosis. Semen Analysis is essential to validate the sperm quantity and quality. Genetic evaluation and testicular biopsy may be required in special cases.

Know more about Male Infertility Evaluation

A woman’s health history includes her menstrual pattern, previous obstetric performance, sexual disturbances or pelvic symptoms, medical or surgical history, addictions, etc complimented by a pelvic examination, pelvic ultrasound, PAP test, and blood tests to look at the general health status. Genetic evaluation is considered in special cases like prolonged infertility, elderly woman, family history of genetic disease, etc. Specific tests include:-

1. Baseline hormonal profile: Various hormones secreted from the hypothalamus, pituitary and ovaries are involved in the egg development and release process, e.g. FSH, LH, Estrogen, Progesterone, TSH and Prolactin. Abnormal hormonal levels are related to subfertility.

2. Ovarian Reserve: Qualitative and quantitative adequacy of the eggs is important for fertility. Baseline ultrasound on Day 2/3 of menses aided by hormonal assessment like AMH and FSH help to determine a woman’s egg reserve.

3. Progesterone level  in the mid-luteal phase (Day 21-23) gives an indication of ovulation in regular cycles.

4. Tubal patency: At least one patent tube is needed to achieve pregnancy naturally or through IUI. Tests like HSG, SIS, HyCoSy, HyFoSy, Laparoscopy help to detect the passage of dye/fluid/foam from the uterus via the tubes into the peritoneal cavity.

5. Uterine Cavity: Hysteroscopy allows real-time visualization of the uterine cavity and also enables operative procedures if required.

Know more about Female Infertility Evaluation

Treatment

Treatment has to be individualized based on the need and personal preferences of the couple. Correction of general health, and appropriate guidance for Timed Intercourse help 10% of couples to achieve pregnancy every month.

Ovulation Induction can be tried with oral medicines and/or injections to enhance the egg development. Fertility enhancing surgery to treat associated tubal, uterine or ovarian diseases in females and varicocele surgery  in males improve the outcome.

IUI allows the timed insertion of washed semen in the uterus, with a 15-20% positive outcome. Assisted conception with IVF and/or ICSI enhances the success rates up to 50-60%. Gamete donation can be considered if needed.

Know More About Treatment Cost

So, with the boon of Science, lets begin again… because the moment you are ready to quit is the moment right before the miracle happens.