How do I know I have difficulty to conceive?

Statistically up to 90% of the normal couple with regular sexual activity would have conceived in 1 year. Therefore, it is time to seek medical attention if you and your partner have been having regular, unprotected sex for one year and there is still no pregnancy. It is however advisable to see a doctor earlier if you are older than 35 years, or do not experience regular monthly periods, or have previous history of pelvic infection or surgery etc.

What are the possible causes?

The top four causes that may contribute to Infertility are ovulation disorders, endometriosis, fallopian tubes obstruction , and sperm problems. They may also coexist , which further hamper fertility. There are also other less common causes like cervical factors, systemic illness, sexual dysfunctions etc.

What are the investigations required?

A detailed medical consultation and examination is necessary, to find out the possible underlying reasons for the difficulty to conceive. Blood tests to measure hormones relevant to reproductive functions and pelvic ultrasound are the initial investigations needed. A semen analysis is also preferred. Depending on the results, further test may be needed to check for the patency of the fallopian tubes and exclude endometriosis. This may involve a minor day surgery procedure ,diagnostic laparoscopy and hydrotubation. Alternatively a special X ray can be arranged to test the fallopian tubes.

What are the type of treatments available?

Treatment methods are highly tailored to individual needs and the causes of Infertility found. In principle, it should start with simpler, cheaper, and safer methods before embarking on the more invasive and expensive ones.

The range of treatment options includes:

• determination of fertile periods and timing
• medications helping in ovulations
• intrauterine insemination
• surgery to treat endometriosis, release blockage of fallopian tubes if possible, remove ovarian cysts or fibroids that may interfere with fertility
• superovulation and insemination(SO-IUI)
• in vitro fertilization (IVF)
• invitro fertilization-ICSI