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When to seek treatment

When a couple is not able to conceive after living together for a period of one year (or 6 months if maternal age > 35 years / Known or suspected cause of infertility eg PCOS, endometriosis etc ), you should seek advice and treatment for the same.

Factors affecting fertility

There are various factors affecting fertility like:

  • Maternal Age
  • Timing of intercourse
  • Previous conception
  • Occupational hazards
  • Diet
  • Lifestyle habits – smoking, alcohol etc
  • Stress and anxiety

Causes of infertility:

There are various reasons for infertility

Male factor –

According to WHO the normal semen parameters are

Semen volume: 1.5 ml

Total sperm in the ejaculate: 39 million

Sperm per ml: 15 million/ml
Vitality: 58% live
Progressive motility: 32%
Total Motility: 40%

Morphologically Normal: 4%

There may be decreased sperm count, impaired motility, the complete absence of sperms, higher abnormal forms which may result in infertility. A basic semen analysis is usually sufficient to identify the cause. In case any abnormality is identified, further investigations are done and treatment is started accordingly. Sometimes a hydrocele or varicocele is responsible for this problem and corrective surgery is advised.

Simple suggestions for improving the semen quality

Do not wear tight clothes

Smoking and alcohol impair semen quality.

Female factor

Blocked tubes – usually detected on HSG (tube test) or laparoscopy, it may be the result of previous pelvic infection, tuberculosis etc.

Fibroids – Tumors in the body of the uterus are called fibroids. Most of the fibroids cause menstrual problems rather than infertility. However, sometimes a fibroid in the cavity of the uterus can cause problems. A myomectomy (surgery for the removal of fibroid) usually takes care of the problem

Endometriosis – The cause of endometriosis is usually unknown and it may cause dysmenorrhea, infertility etc. Depending upon the degree of problem various treatment options are offered to the patients.

Polycystic ovarian disease – These days PCOS has become a very common problem. The reason for infertility in PCOS is usually anovulation, that is no egg is formed. It is basically a hormonal disease, which may cause various other problems like acne, menstrual disorders, increased hair growth, weight gain.

Thorough workup of the couple is required to understand the cause of infertility and accordingly, the treatment option most suited to the couple is advised.

There are various treatment options available like ovulation induction, intrauterine insemination, in vitro fertilization (test tube baby), ICSI, Donor egg, donor semen, surrogate mother etc.


Ovulation induction – Medicines and injections are given to make and improve the quality of the egg. In case, IVF is being planned, then multiple injections are given to make multiple eggs. Each individual responds in a different way to these drugs. Some patients may feel bloating, mood fluctuations, slight weight gain with these medicines. However, most of these side effects are temporary.

IUI – The process of inserting processed semen sample inside the uterus is called intrauterine insemination. Usually, after ovulation induction, the semen sample is collected and prepared in the lab and then inserted in the uterus. It is an OPD procedure and does not require admission. It is usually a painless procedure.

IVF – commonly called test tube baby, it is an artificial reproductive technique in which the process of fertilization occurs outside the female body. In this usually, ovulation induction is done to make multiple eggs. These eggs are then collected under ultrasound guidance. The semen sample is also collected at the same time and processed in the lab. After that, the eggs are left to fertilize (IVF) or ICSI (one sperm is introduced inside the egg) is done if required. The patient is then discharged on medications and the result is known after 2 weeks.

Donor egg – When the mother is unable to produce eggs or for some reason, the quality of eggs is not good, the services of a donor can be employed.

Surrogate mother – When the mother is unable to carry a pregnancy, the services of surrogate are employed. The surrogates are usually well selected and are free of disease.

Tips for the infertile couple

  • Use some relaxation technique. The treatment of infertility can be very stressful and some unwinding technique or hobby can be very helpful.
  • Communication and understanding between both the partners are very important. Infertility should not result in a blame game between the partners
  • Regular and step ladder treatment is best for infertility. The work up of an infertile couple takes time and has to be done patiently’
  • Dr. Madhu Goel understands that infertility is a very taxing problem. Various investigations, long drawn treatment, timed intercourse, the repeated sense of failure coupled with social pressures makes it a physical, emotional and financial burden.
  • Hence, she schedules the appointments in such a way that she can give adequate time to each patient and offer the best possible treatment.

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