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Infertility Male and Female

Infertility Male and Female

Inability of a couple to conceive after 1 year of regular unprotected intercourse can be termed as infertility.

When the age of the female partner is more than 35, infertility treatment can be started after 6 months of regular unprotected intercourse.

Causes of Infertility

 

Female Factor

 
  • Ovulatory dysfunction
  • Tubal dysfunction
  • Endometriosis
  • Uterine factors
  • Diminished ovarian reserve
  • Other causes: cervical factor, immunological infertility etc
  • Male Factor

 
  • Oligospermia
  • Azoospermia

Combined Factors

 

Unexplained infertility


We individualize the infertility treatment for each and every couple. At Shalby infertility clinic, all infertility patients receives preconceptional care before commencing actual treatment which is aimed at optimizing medical, lifestyle, emotional & nutritional factors should be an integral part of fertility therapies.
 

Approach to Female infertility


Management of the patients can only be appropriately provided once the cause/s of the problem are discovered, which in turn requires detailed history, physical examination and appropriate investigations to be undertaken.

 

Traditionally, infertility investigations are generally started after a year of involuntary infertility. However, it can be started earlier in some cases like advanced female age, chronic anovulation or a history of previous pelvic surgery.
 

Pelvic ultrasound


It gives accurate non invasive assessment of the pelvic organs

 

Baseline Ultrasound scan: congenital anomalies, uterine fibroids, hydrosalpinges, ovarian cysts, endometriomas, polycystic ovaries and ovarian volume with antral follicle count.

Saline sonography may be used to differentiate thick endometrium from submucus fibroid and endometrial polyp. It can also be used to differentiate thin endometrium from Ashermann’s syndrome.

Color & pulsed Doppler ultrasound can be used to predict ovarian responsiveness to gonadotropin stimulation and endometrial receptivity to embryo implantation.

3D technology may be used to diagnose different uterine abnormalities and assessing its degree of interference with endometrial cavity. Ovarian volumes and endometrial volumes can be measured accurately with 3D technology which helps in prediction of success of an IVF cycle.
 

Tests for ovulation


BBT (Basal body Temperature) charts: generally not advocated as it is cumbersome for the patient

 

Serial ovarian ultrasound for follicular study: preferred method

Mid luteal serum progesterone level

Assessing LH surge by measuring blood/urine LH level

Endometrial biopsy: not routinely preferred as it do have wide variation in results

Tests for tubal function

HSG: most widely used tubal patency test. It has added advantage of diagnosing uterine defects like fibroids, polyps & synechia. It has got disadvantage of limited ability to assess peritubal adhesions and infection risk. HSG has 65% sensitivity & 83% specificity in diagnosing tubal obstruction.

HyCoSy (Hysterosalpingo contrast sonography): tubal patency is assessed using transvaginal ultrasound and an injection of a solution containing gas microtubules stabilized on galactose microparticles. It has got the advantage of avoidance of X-ray exposure and assessment of ovaries simultaneously.


Salpingoscopy & Falloposcopy: It is possible to examine whole length of fallopian tube using these methods. Currently, both approaches are of research interest only.

Laparoscopy: It is gold standard test for assessing tubal patency. In addition to tubal patency
 

Approach to male infertility


Abnormalities in sperm production or function can account for 35 -40% of all cases of infertility.

 

Semen Analysis: It is the hallmark of male infertility evaluation.

Specimen is to be obtained following 2-7 days of abstinence from sexual activity, preferably obtained with masturbation in sterile, plastic, widemouth container. Semen should be delivered to the laboratory within 30 minutes of collection and to be transported at room temperature.

World Health Organization (WHO), normal values for semen analysis

Parameter Normal values
Liquefaction Complete within 60 minutes at room temperature
Appearance Homogenous, gray & opalascent
Consistency Leaves a pipette as discrete droplets
Volume 2 ml or more
pH 7.2 or more
Concentration 20 million sperms/ml semen or more
Total number 40 million sperms per ejaculate or more
Motility 50% or more with forward progression, or 25% or more with rapid progression within 60 minutes of collection
Morphology 30% or more with normal forms
Vitality 50% or more
Leucocytes Fewer than 1 million/ml

In azoospermic or oligospermic men, Serum FSH level and scrotal sonography with Doppler can be helpful.

Dr. Nimisha Pandya
M.D.(OB&GY)
nimisha.pandya@shalby.org
Designation :   
Infertility Specialist
Department :   
Obstetrics and Gynaecology
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We at Shalby Hospitals believe in making available High Quality, expert healthcare to people across the world by inventing, adapting and imbibing World's Best technologies and practices. Providing Total Health Care under one roof at most affordable costs has been our passion which helped us establishing a chain of multi-specialty hospitals and vibrant OPD Centres across India and in many parts of the world. Shalby today enjoys a place of pride in the Medical Tourism Map of India as a favoured destination. Our journey continues in tandem with our mission of providing enduring health solutions and our hospital chain built around this philosophy shall outlive the expectations of our valued patients, worldwide.