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Q. We have been trying for a baby since the past two years but failed. What could be wrong and what do we need to do ?
A. We know today that 50% of infertility is due to a male
factor. A simple semen analysis for your husband would be the
first test. Subsequently, we could run routine hematological investigations
for you followed by an transvaginal ultrasound, a hysterosalpingography,
hormonal estimations and if required a laparoscopy and hysteroscopy.
Once we have run through the above investigations, we would be
in a position to suggest remedial measures.
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 vagina. 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.
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.
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