FAQs on Infertility from Malpani Infertility Clinic.Q. My husband and I have an active
sex life, we are both healthy, and my periods are regular.
However, we have still not conceived ! Please help !
A. You need to remember that it's not possible to
determine the reason for your infertility until you undergo tests to
find out if your husband's sperm count is normal; if your fallopian
tubes and uterus are normal; and if you are producing eggs. Only after
undergoing these tests will your doctor be able to tell you why you are
not conceiving. While testing does cause considerable anxiety, it's far
better to intelligently identify the problem so that we can look for the
best solution.
Q. How can I determine my
"fertile" period ?
A. Your fertile period is the time during which having
sex could lead to a pregnancy. This is the 4-6 days prior to ovulation (
release of a mature egg from the ovary). Women normally ovulate 14 days
prior to the date of the next menstrual period. If you are
mathematically challenged, you can use this
free
online ovulation calendar .
Q. My gynecologist has done an internal
examination and said I am normal. Do I still need to get tests done
to determine why I am not conceiving ?
A. A routine gynecological examination does not provide
information about possible problems which can cause infertility, such as
blocked fallopian tubes or ovulatory disorders. You need a systematic
infertility workup.
Q. Do painful periods cause
infertility ?
A. Painful periods do not affect fertility. In fact, for most
patients, regular painful periods usually signal ovulatory cycles.
However, progressively worsening pain during periods (especially when
this is accompanied by pain during sex) may mean you have endometriosis.
Q. My periods come only once every 6
weeks. Could this be a reason for my infertility ?
A. As long as the periods are regular, this means ovulation is
occurring. Some normal women have menstrual cycle lengths of as long as
40 days. Of course, since they have fewer cycles every year, the number
of times they are "fertile" in a year is decreased. Also, they need to
monitor their fertile period more closely, since this is delayed (as
compared to women with a 30 day cycle).
Q. My husband's blood group is B positive
and I am A negative. Could this blood group "incompatibility" be
a reason for our infertility ?
A. There is no relation between blood groups and fertility.
Q. After having sex, most of the semen
leaks out of my vagin. How can we prevent this ? Should we change
our sexual technique ? Could this be a reason for our infertility ?
A. Loss of seminal fluid after intercourse is perfectly normal,
and most women notice some discharge immediately after sex. Many
infertile couples imagine that this is the cause of their problem. If
your husband ejaculates inside you, then you can be sure that no matter
how much semen leaks out afterwards, enough sperm will reach the
cervical mucus. This leakage of semen ( which is called effluvium
seminis) is not a cause of infertility. In fact, this leakage is a good
sign - it means your husband is depositing his semen normally in your
vagina. Of course, you cannot see what goes in - you can only see what
leaks out - but the fact that some is leaking out means enough is going
in!
Q. My colleagues at work tell me that if
we "work" hard at getting pregnant, and want it enough, we definitely
will ! In fact, my mother in law is even suggesting that the fact that I
am not conceiving means that subconsciously I do not wish to have a baby
( because it may interfere with my career) and that this
psychological barrier is the reason for our infertility.
A. Unlike many other parts of your lives, infertility may be
beyond your control. Don't blame yourself if you are not getting
pregnant - it's a medical problem which often needs appropriate medical
treatment. The attitudes you are encountering are often born out of
ignorance - and are a kind of "victim-blaming" - ignore them !
Q. My grandmother says that if I just
pray and have faith, I will definitely conceive. How far is this
true ?
A. Believing in god can help you to maintain a positive outlook -
but sheer will and blind faith won't overcome a physical problem like
blocked tubes or absent sperms.
Q. My husband refuses to get his semen
tested. He says the fact that it is thick and voluminous means it
must be normal.
A. Semen consists mainly of seminal fluid, secreted by the
seminal vesicles and the prostate. The volume and consistency of the
semen is not related to its fertility potential, which depends upon the
sperm count. This can only be assessed by microscopic examination.
Q. My sister conceived only after 6
years of marriage. Does this mean I will also have difficulty
conceiving ?
A. If your mother, grandmother or sister has had difficulty
becoming pregnant, this does not necessarily mean you will have the same
problem! Most infertility problems are not hereditary, and you need a
complete evaluation.
Q. My doctor just did a physical
examination for me, and he feels that the reason for my infertility is
that my uterus is tipped backwards, and this prevents the sperm
from swimming into the uterus. He is advising I have surgery to correct
this problem. Should I go ahead ?
A. About one in five women will have a retroverted uterus. If the
uterus is freely mobile, this is normal, and is not a cause of
infertility. This is not an indication for surgery!
Q. My husband says we should be having
intercourse every day to achieve pregnancy. Is this true ?
A. Sperm remain alive and active in woman's cervical mucus for
48-72 hours following sexual intercourse; therefore, it isn't necessary
to plan your lovemaking on a rigid schedule.
Q. My friends say I should have sex
exactly on the day I ovulate to get pregnant. How can I do
this ?
A. Although having sexual intercourse near the time of ovulation
is important, no single day is critical. So, don't be concerned if
intercourse is not possible or practical on the day of ovulation.
Q. My sister in law is advising me to keep
a pillow under my hips during and after intercourse . Will this
increase my chances of conceiving ?
A. Sperm are already swimming in cervical mucus as sexual
intercourse is completed and will continue to travel up the cervix to
the fallopian tube for the next 48 to 72 hours. The position of the hips
really doesn't matter.
Q. My mother feels I am too tense,
and that if I just relax, I'll get pregnant.
A. If pregnancy has not occurred after a year, chances are there
is a medical condition causing infertility. There is no evidence that
stress causes infertility. Remember, all infertile patients are under
stress - it's not the stress which causes infertiliity, it's the
infertility which causes the stress!
Q. I just had a HSG ( X-ray of the uterus
and tubes) done, and this shows my tubes are blocked. I've never
had symptoms of a pelvic infection, so how could my tubes get blocked ?
A. Many pelvic infections have no symptoms at all, but can cause
damage, sometimes irreversibly, to the tubes.
Q. My doctor has advised me to take
fertility drugs . I don't want to take them because if I am scared that
if I do, then I'll have a multiple births.
A. Fact: Although fertility drugs do increase the chance of
having a multiple pregnancy (because they stimulate the ovaries to
produce several eggs), the majority of women taking them have singleton
births.
Q. Can the HMG injections used for
superovulation make me fat ? I am worried about the side-effects
of hormones, and what the result of pumping my body with these
shots will be.
A. Fact: The hormonal injections used for
superovulation are natural hormones - gonadotropins. These are the same
hormones your body normally produces, in order to make you ovulate every
month. These hormones are promptly excreted in the urine, and do not
"hang around" your body or produce any long-term effects. They have been
used for over 40 years, and have an excellent safety track record !
Q. If I do IVF and grow so many eggs as a
result of superovulation, will I run out of eggs and
become menopausal sooner ?
A. Fact: This is a very common concern, but
the fact is that in every cycle , 40 follicles in your ovary start to
mature. Of these 40 follicles, only one will continue to grow, become
the "dominant follicle" , and ovulate . ( This is why most women have
one baby at a time, unlike rabbits who have lots of rabbits when they
get pregnant, because so many more of their follicles mature at the same
time). The rest of the follicles die naturally, this process being
called atresia. This means that every cycle, 40 of your eggs die
naturally, no matter what you do. When we superovulate you, we rescue
the eggs which would otherwise have died normally. This means that
you do not " run out of eggs " as a result of the superovulation !
Q. My husband's sperm count varies
every time we test it ! How do we determine what the "real" sperm count
is ?
A. Even a normal ( fertile ) man's sperm count can vary
considerably from week to week. Sperm count and motility can be affected
by many factors, including time between ejaculations, illness, and
medications. There are other factors which affect the sperm count as
well, all of which we do not understand.
Q. I have no problems having sex. Since I
am virile, my sperm count must be normal.
A. There is no correlation between male fertility and virility.
Men with totally normal sex drives may have no sperms at all.
Q. I don't think infertility treatment
should not be offered in India, because there are too many babies
in this country already. Why should we exacerbate the population problem
by producing more? In any case, IVF treatment is too expensive for India
to be able to afford.
A. The right to have children is a fundamental right of every
human being and a very basic biological urge. Just because a neighbour
has too many children should not deprive the infertile couple of their
right to have their own.
IVF and related technologies are undoubtedly expensive, but, then, so is
heart surgery. Yet no one objects when over Rs 1 lakh are spent to try
to salvage the heart of a 70 year old man (whose life expectancy in any
case is only about 5 years and is not extended by the surgery). Why then
should medical technology not be used to help couples in their thirties
(with their whole lives ahead of them) have their own baby? In fact, IVF
is a much more cost-effective use of medical resources than a number of
other accepted surgical procedures (such as joint replacement surgery or
kidney transplants).
Q. My semen analysis report shows I have
no sperm in the semen ( azoospermia ). Is this because I used to
masturbate excessively as a boy ?
A. Masturbation is a normal activity which most boys and men
indulge in. It does not affect the sperm count. You cannot "run" out of
sperms, because these are constantly being produced in the testes.
Q. My wife is frigid and does not enjoy
having sex. Could this be the reason for her infertility?
A. There is no connection between sexual pleasure and
fertility. Don't forget that even a woman who gets raped can get
pregnant! And don't forget that the commonest reason women do not enjoy
sex is because their husbands are unskilled lovers ! Maybe you should
improve your sexual technique, and spend more time in foreplay and in
pleasuring your wife.
Q. How long do I need to be in India if I
need to come to your clinic for IVF treatment ?
A. You would need to spend about
20 days in India, starting from Day 1 of your cycle. From Day 4 - Day 9,
you can even visit the Taj or Ajanta-Ellora; or go to Kerala for an
ayurvedic massage to de-stress yourself.
Go ahead and explore India -
it's a completely different
world ! If your local doctor agrees, you can
start your meds in your hometown
and come directly on Day 10, which means you would have to spend only
about 10 days in Bombay. Hotel rooms cost about US $ 50 per night in
India.
Q. Do you offer a shared-risk program ?
A. Yes, we do. You can read about our
"money-back" option
here.
Q. Can I talk to any of your patients ?
A. Yes, you can. Some of our patients have kindly agreed to act
as "email buddies" and will be happy to talk to you by email. You can
read their stories and
contact them
through our website page here.
Q. Where were you trained ?
A. We completed our MD in Obstetrics and Gynecology from India's
premier medical college, KEM Hospital in Bombay. We then received
advanced training in IVF at King's College Hospital, London; and the
University of California at San Francisco.
Q. Can you help with travel, tickets
and hotel accommodation ?
A. Yes, we'll be happy to do so. You can
email our travel agent, Mr Tulshan for more information.
Do you need more information on infertility ? Our
book, Getting
Pregnant - A Guide for the Infertile Couple, is a very valuable
resource - and the full book is available
online, free of charge!
Do you have a question you'd like answered ? Please
Ask-the-Doctor.
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