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Submitted by PatientsEngage on 5 December 2014
A woman in a white dress against a black board with a thought bubble of a baby

Dr Shital Patel answers all your questions on fertility – from upping your chance of natural conception to treatment options.

1. What can I do to improve my chances of getting pregnant naturally?

Before planning to conceive, it’s important to make sure you are healthy and start on daily prenatal vitamins. Also avoiding stress, smoking, alcohol, substance abuse, certain medications etc will all help improve your chance of conceiving. 

2. What is the fertile window period?

The fertile window is the time when pregnancy is most likely to occur and is called the Ovulation period. This occurs around the 12-17th cycle, day 1 being the day your menses start. This period can differ with each woman.

3. How do I know when I’m ovulating?

Some of the methods used to determine one’s ovulation are:

  • Increase in cervical mucus secretions that occur before and during ovulation.
  • Series of cramps in the lower abdominal area when eggs are released.
  • Increase in the Basal body temperature due to a progesterone surge.
  • Ovulation predictor kits are home urine tests that detect the rise in the Luteinizing hormone (LH). LH is a hormone produced by the pituitary gland when there is a rise in oestrogen. There is an LH surge right before ovulation and it helps release the egg. 

4. When should I consult a doctor about not being able to conceive?

The American Society of Reproductive Medicine recommends consulting an OBGYN if:

(i) The woman is under 35 years of age and has been trying to conceive for more than 1 year or

(ii) if the woman is over 35 years of age and has been trying to conceive for over 6 months.

5. What causes infertility in women?

Infertility in women can be due to anything that may be hampering the normal functioning of the uterus, ovaries or fallopian tubes. This can include Polycystic Ovary Syndrome (PCOS), hormonal imbalance, irregular periods and ovulation, premature ovarian insufficiency, menopause, infections, endometriosis, tubal obstructions, fibroids etc.

6. What are the risk factors for female infertility?

Increasing age (>35 years), smoking, excessive alcohol use, illicit drug use, extreme weight gain or weight loss, and stress are the common risk factors.

7. What causes infertility in men?

Infertility in men can be due to various causes:

  • Lifestyle factors such as stress, smoking, chronic alcohol abuse, obesity, infections/STDs, use of recreational drugs, medications, steroid use, exposure to environmental toxins like lead etc
  • Physical Anomalies such as varicocele, torsion, damaged sperm ducts, infection, retrograde ejaculation etc.
  • Hormonal problems due to disorders such as Hypothyroidism, Congenital Adrenal Hyperplasia, Hyperprolactenemia, etc.
  • Psychological issues like Erectile dysfunction, Premature Ejaculation, or ejaculatory incompetence.

8. What are the treatment options available for women?

Treatment options can include lifestyle changes, supplements, surgery, medication, or assisted reproduction. 

Assisted Reproductive Technology (ART) can include several treatments such as:

  • In Vitro Fertilization (IVF) - eggs are harvested from the ovary and fertilised in the laboratory with the sperm and then inserted into the uterus.
  • Gamete Intrafallopian Transfer (GIFT) - eggs are harvested and mixed with the sperm in the laboratory before placing them immediately into the fallopian tube to allow natural fertilisation.
  • Zygote Intrafallopian Transfer (ZIFT) - is similar to GIFT but the eggs are fertilised in the laboratory to form a zygote (embryo) before inserting them into the fallopian tube.
  • Intracytoplasmic sperm injection (ICSI) - is when the woman’s eggs are removed first and then the man’s sperm are removed from the scrotum or sperm passages. The sperm is directly injected into the eggs and after the zygotes are formed, they are inserted into the uterus.

In all cases, the woman is given hormones to stimulate multiple eggs to be produced and matured for fertilisation. Also more than one egg/embryo is usually inserted into the reproductive organ to increase chances of pregnancy.

9. What is IUI?

Intrauterine insemination (IUI) is an infertility treatment that is commonly called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. The woman is sometimes also given medicines to stimulate ovulation before the procedure. It is often used to treat mild male factor infertility and unexplained infertility.