A woman is most fertile when she is ovulating. Ovulation typically occurs within day 11 through day 21 of a woman’s cycle.
Counting from the first day of a woman’s last period, day one is the first day a woman starts bleeding and the 11th day is most likely to be the first day of ovulation. The 21st day is most likely the last. A woman’s period comes between the 28th and 32nd day of the cycle. The pattern may differ from one woman to another depending on a variety of factors.
Infertility is a worldwide health issue with high impact on the individuals involved as well as the society as a whole.
- 25% of infertile couples have more than one cause of infertility.
- According to a recent report on the status of infertility in India by WHO, of all infertility cases, about 50% is due to male factor infertility.
- The current increase in female infertility is often attributed to more women delaying starting a family until later in life.
Visit a doctor if you have been unable to conceive a child after a year of regular and unprotected intercourse. Do see a doctor sooner if you have any of these signs and symptoms:
- Erection or ejaculation problems, low sex drive, or other problems related to sexual function
- Pain, lump, swelling, or discomfort in the testicle area
- A history of prostate, testicle, or sexual problems
- A penis, groin, testicle, or scrotum surgery
Lifestyle factors—what you eat, where you live, how well you sleep, and other behaviors—leave a profound effect on health. Fertility is no exception.
Several lifestyle factors affect fertility in women, in men, and both. Research shows that:
- Obesity is linked to poor sperm quality and lower count in men.
- Among obese women, especially those with polycystic ovary syndrome (PCOS), losing body weight improves the likelihood of ovulation and pregnancy.
- Being underweight is linked to ovarian dysfunction as well as infertility in women.
- Strenuous physical labor tends to reduce sperm count in males.
- Excessive exercise affects ovulation and fertility among women.
- Body-building medications or androgens leave a negative impact on sperm formation.
- Substance use, including smoking tobacco, marijuana use, excessive alcohol consumption, and use of illegal drugs like cocaine and heroin reduce fertility in men and women.
- Having high blood pressure changes the shape of sperm, reducing fertility.
- Exposure to persistent organic pollutants and endocrine-disrupting chemicals (EDCs) affect both male and female fertility.
You always have the option of visiting a fertility specialist for a complete examination to determine if you or your partner has fertility issues. You can also choose to do an at-home fertility test to determine the same.
Most eggs will fertilize when they are placed in a culture dish with several thousand normal sperms. This process is known as in vitro fertilization (IVF). If not enough normal-functioning sperms available for IVF, fertilization will occur when a single sperm is injected into each egg with the help of an intracytoplasmic sperm injection or ICSI.
There are rare occasions when fertilization does not occur even with ICSI due to an inherent problem related to either the eggs or sperm. In such cases, the use of donor sperm or donor eggs will usually result in fertilization. Your fertility specialist and IVF laboratory personnel will help determine which approach is most likely to result in egg fertilization.
A response to ovarian stimulation depends on several factors. The most important one revolves around the availability of eggs, hormone levels, proper administration of medications, and lifestyle/environmental factors.
In order to respond to ovarian stimulation, a woman must have an ovarian reserve. A woman with diminished ovarian reserve – identified by a high blood level of follicle stimulation hormone (FSH) – a low blood level of Anti-Müllerian hormone (AMH), or a low antral follicle count, may not have as robust (or any) response to stimulation. For such patients, an alternate stimulation protocol may be tried or donated eggs (from a woman known/unknown to the patient).
It is possible that a woman has the required number of eggs but insufficient pituitary hormones to respond. In such a scenario, taking a medication that contains both FSH and luteinizing hormone (LH) may result in an optimal response.
Lifestyle factors can also affect a woman’s response to stimulation. Maintaining body weight, diet, and stress and limiting the consumption of tobacco, alcohol, and other substances can improve the response to ovarian stimulation.
For further information on improving your response to ovarian stimulation, speak to your physician.
The specifics of what occurs during the initial consultation vary from patient to patient, as each patient or couple presents with a unique set of problems and questions. The initial visit usually includes an in-depth physical examination followed by an ultrasound. Additional testing is generally required after the initial visit which may include blood work, a semen analysis, and hysterosalpingography also known as uterosalpingography (a radiologic procedure that evaluates the shape and patency of the fallopian tubes and the uterine cavity).
A seminogram or semen analysis evaluates certain characteristics of semen and the sperm contained. It is done to evaluate male fertility either for those seeking pregnancy or to check the success rate of vasectomy.
A semen analysis evaluates these four main parameters:
- Volume – normally 2 ml or greater
- Concentration – normally 20 million/ml or greater
- Motility or movement – normally 50% or greater
- Morphology or shape – 15% or greater in normal shape
If the semen analysis reveals abnormalities, fertility treatments can help treat most of the issues. Your physician will inform you of the results along with the ideal next step in the treatment.
This is a very broad question which requires an in-depth discussion with a patient or the couple. In general, the treatment options include observation, lifestyle management, including nutritional adjustment and exercises, intra-uterine insemination (IUI), surgery like hysteroscopy or laparoscopy, ovulation stimulation with oral or injectable medications, in vitro fertilization (IVF), intra-cytoplasmic sperm injection (ICSI), use of donor gametes (oocytes and sperm), and gestational surrogacy.
Certain high-impact exercises like jumping, running, or intense yoga positions can increases the chances of ovarian torsion. Hence, women who are undergoing fertility treatment are advised to avoid vigorous exercises. For further details, contact your doctor.
On the day of IUI, the semen sample is prepared for insemination. If the semen is a fresh sample, the preparation takes 30-60 minutes. The insemination involves taking the washed/prepared sperm and placing it gently into the uterine cavity using a soft flexible catheter. Then, the patient is made to lie down for 10 minutes before leaving. Generally, there are no hard and fast restrictions after IUI and you may go back to work. Some patients may need to take oral or vaginal progesterone starting two-three days after the procedure.
Embryo transfer is typically performed within three to five days (occasionally six days) after egg retrieval. We strictly adhere to the American Society for Reproductive Medicine (ASRM) guidelines, whereby typically one or two embryos (rarely more) are transferred into the uterine cavity. However, every patient will have an individualized treatment plan to maximize conception while minimizing the chance of multiple pregnancies. You should not experience any pain with this procedure. It is performed under abdominal ultrasound guidance and the patient is required to have a full bladder for proper positioning of the uterus. After the embryo transfer, we recommend minimal physical activity for at least 48 hours. The patient need not be strictly bedridden.
Ovarian hyperstimulation syndrome (OHSS) generally affects women who take injectable hormone medications aimed at stimulating egg development in the ovaries. Naturally, it occurs while the woman is undergoing ovulation induction, IVF, or IUI. Excessive hormone medication in the body leads to OHSS. Less often, OHSS may happen while using oral fertilization medications like clomiphene. Occasionally, it occurs spontaneously unrelated to any fertility treatment.
Symptoms of OHSS often start showing within 10 days after using injectable medications to stimulate ovulation. Symptoms can range from mild to severe and may worsen or improve over time. With mild to moderate OHSS, symptoms can include:
- Mild to moderate abdominal pain
- Nausea or vomiting
- Diarrhea
- Abdominal bloating
- Tenderness in areas surrounding ovaries
- Sudden weight increase of more than 3 kilograms
With severe OHSS, you might have:
- Rapid weight gain —15 to 20 kilograms within five to 10 days
- Tight or enlarged abdomen
- Severe abdominal pain
- Persistent nausea and vomiting
- Decreased urination
- Blood clots in legs
- Shortness of breath
To decrease your chances of OHSS, you will require an individualized plan for your fertility medications. Common strategies to help prevent OHSS include:
- Adjusting medication
- Coasting
- Avoiding the use of a human chorionic gonadotropin (HCG) trigger shot
- Freezing embryos
With severe OHSS, you may be admitted to the hospital. Your doctor may give you medication to lessen your symptoms. Serious complications may require surgery or intensive care. You may also need anticoagulant medications to decrease the risk of blood clots in your legs.
Lifestyle and home remedies for treating OHSS include:
- Trying an over-the-counter painkiller
- Avoiding sexual intercourse as it may cause an ovarian cyst to rupture
- Avoiding strenuous or high-impact activities.
Call your doctor if your signs and symptoms get worse.
At a gestational period of five weeks, we expect to see a gestational sac alongside a yolk sac. At six weeks, we expect to see a fetus of three to five millimeters with a heartbeat of at least 90-100 beats/minute. At seven weeks, we expect the fetus to double in size and the heartbeat to increase to at least 120-130 beats/minute. At eight weeks, we expect the fetus to double further and the heartbeat to reach at least 150 beats/minute.
Get in touch with the doctor immediately. Do not panic or visit the clinic unless specifically asked as vaginal spotting during early pregnancy may not indicate an emergency.
40 years following the birth of the first IVF baby, Louise Brown, there is ample data to suggest that children conceived through IVF suffer no major birth defects.
Usually, patients are asked to complete one or two full menstrual cycles before going for another ART cycle.
If you become pregnant, you will be asked to visit the clinic for a repeat blood test and an ultrasound to ensure a successful pregnancy. On confirming a fetal heartbeat, you are likely to be referred to an obstetrician for the remaining pregnancy period.
