Common Diagnosis

On your first visit, our team would evaluate your history, review your previous reports, perform some tests and make treatment recommendations

The common tests required are:

  • Semen analysis of the male partner
  • Transvaginal ultrasound of the wife for various pelvic pathologies, estimation of egg reserve (antral follicle count).
  • Hormone estimations: AMH (most important), FSH, LH, Prolactin and TSH.
  • Hysterosalpingography for tubal patency.
  • Operative laparoscopy and hysteroscopy for enhancing fertility (fibroids, septum, polyps, endometriosis, chocolate cysts, hydrosalpinges).

The common diagnoses for you would then be:

Tubal factor – blocked fallopian tubes. Here, it very important that any hydrosalpinx (water filled in the tube) should be removed before proceeding with IVF. If not possible, the part where the tube joins the uterus should be clipped. If this is not done, the water from the tubes will flush out the embryos which are transferred at IVF and cause repeated failures

Endometriosis – The first treatment option is a good laparoscopic surgery with enucleation and removal of chocolate cysts and pelvic adhesions. Thereafter, the couple may try naturally or optimize their chances with Intrauterine insemination. If this fails, early resort to IVF is often the best way out

Polycystic Ovaries – Treatment begins with ovulation induction 2-3 months followed by IUI for 2-3 months. If all this fails, IVF is extremely successful for this group of patients. Modern protocols using FSH injections with an antagonist (cetrorelix) followed by IVF and freezing of all embryos are very successful for these patients. With IVF and transfer of only frozen embryos, they can expect a 60% chance of pregnancy in two cycles.

Male factor - Patients with low sperm counts or poor sperm motility would need an andrological evaluation and some tests such as serum FSH, Prolactin, Testosterone, scrotal color Doppler and others. Thereafter, medicines are prescribed for 3-6 months. Please remember that the efficacy of medicines would only be known after 3 months so it is futile to repeat the semen analysis before that. Sometimes, the doctor might recommend a simple surgery such as varicocelectomy. After 6 months, if the problem is not too severe, IUI for 3 cycles could be tried. However, the best and most successful treatment for most cases of sperm problems is ICSI.

Unexplained Infertility. If all the above investigations show normal results you would be categorized as unexplained infertility. These patients are often told that all is normal and it is just a matter of time before they achieve pregnancy. This may be true for some of them but for the majority it implies that there are other factors such as subtle egg and sperm defects or even FAILURE of the sperms to fertilize the eggs which are at play. Unfortunately, there are no tests to prove these events. You would be recommended two to three cycles of IUI followed by ICSI.

Premature ovarian failure or menopause - The best option for these patients is egg donation where they can expect a 60% chance of pregnancy per cycle.

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