Challenges of Fertility and how to overcome to achieve parenthood-Part 2

In the previous article I provided some socio-economic factors that contribute to the delayed child bearing decisions. Now we'll try to get some details. Many couples think there is something wrong with them if they have been married for a few months and "nothing has happened". In reality, infertility is defined as the inability to conceive after a year of trying without protection in women under 35, and 6 months for women over 35. Therefore the key message, especially for younger women, is "Don't get stressed, relax, try regularly and the odds are that you will conceive naturally."

However if you have other issues like thyroid disease ( hypo or hyper), diabetes, severely overweight or other known reproductive problems, it is better to approach a specialist rightaway. Also, if you seem to have a highly irregular menstrual cycle, approach the doctor right away. What kind of doctor is most appropriate ?

You should see a fertility specialist, who is usually a ob/gyn with an advanced degree in reproductive endocrinology. A regular gynaec will not do. Avoid a situation where you waste valuable time with the wrong
doctor. Beware of quacks.

There are 4 important steps to having a child: Ovulation, fertilization ,implantation and gestation.

Inability to ovulate or anovulation is the most common cause of infertility. The problems in ovulation are usually as follows:

* Ovulation cycle not regular
* Body just not producing enough or even any eggs
* Eggs produced but not accessible due to structural problems ( blocked Fallopian tube etc)
* Other ovarian problems like PCOS etc

Dr. Deepa Mukundan, a successful fertility specialist in Trichy, informed me that most of the cases she has treated involved blocked tubes. She felt that women in this ethnic/racial (South Indian) group had a tendency to have this problem.

Couple of approaches are favored by doctors as a starting point. One is to make sure tubes are open - this is done by HSG test or HysteroSalpingogram. A iodine based solution is introduced into the patient's body and an X-Ray is taken. If the X-Ray indicates the liquid leaking from the end of your fallopian tubes, your tubes are open. Next, a popular and cheap drug called Clomid (Clomiphene citrate) is given to increase your ovulation activity. The doc may ask you to start with a low dose and see how you respond. Some people may need larger doses. The approach is to take this for several days, making the eggs mature, and then having intercourse around this time. Some doctors will prescribe a HCG trigger shot ( Ovidrel ) to precisely make the eggs launch at a particular time and then have intercourse at that time.

For many people this works well. Congratulations if you are one of the lucky ones !

This may not work at the very first time. Be patient, be kind to yourself and let the magic work. This is not a microwave meal which will be ready in a definitive timetable

What happens if this doesn't work ? This is only the start of the fertility journey - we'll see what our options are in the next article.

Comments and questions welcome.