FAQs on Infertility from Malpani Infertility Clinic

Reprinted with permission from  Malpani Infertility Clinic

Q.My husband and I have an active sex life, we are both healthy, and my periods are regular. However, we have still not conceived ! Please help !
A. You need to remember that it's not possible to determine the reason for your infertility until you undergo tests to find out if your husband's sperm count is normal; if your fallopian tubes and uterus are normal; and if you are producing eggs. Only after undergoing these tests will your doctor be able to tell you why you are not conceiving. While testing does cause considerable anxiety, it's far better to intelligently identify the problem so that we can look for the best solution.

Q.How can I determine my "fertile" period ?
A. Your fertile period is the time during which having sex could lead to a pregnancy. This is the 4-6 days prior to ovulation ( release of a mature egg from the ovary). Women normally ovulate 14 days prior to the date of the next menstrual period. If you are mathematically challenged, you can use thisfree online ovulation calendar .

Q.My gynecologist has done an internal examination and said I am normal. Do I still need to get tests done to determine why I am not conceiving ?
A. A routine gynecological examination does not provide information about possible problems which can cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a systematic infertility workup.

Q.Do painful periods cause infertility ?
A. Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis.

Q.My periods come only once every 6 weeks. Could this be a reason for my infertility ?
A. As long as the periods are regular, this means ovulation is occurring. Some normal women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are "fertile" in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a 30 day cycle).

Q.My husband's blood group is B positive and I am A negative. Could this blood group "incompatibility" be a reason for our infertility ?
A. There is no relation between blood groups and fertility.

Q.After having sex, most of the semen leaks out of my vagin. How can we prevent this ? Should we change our sexual technique ? Could this be a reason for our infertility ?A. Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, then you can be sure that no matter how much semen leaks out afterwards, enough sperm will reach the cervical mucus. This leakage of semen ( which is called effluvium seminis) is not a cause of infertility. In fact, this leakage is a good sign - it means your husband is depositing his semen normally in your vagina. Of course, you cannot see what goes in - you can only see what leaks out - but the fact that some is leaking out means enough is going in!

Q.My colleagues at work tell me that if we "work" hard at getting pregnant, and want it enough, we definitely will ! In fact, my mother in law is even suggesting that the fact that I am not conceiving means that subconsciously I do not wish to have a baby ( because it may interfere with my career) and that this psychological barrier is the reason for our infertility.A. Unlike many other parts of your lives, infertility may be beyond your control. Don't blame yourself if you are not getting pregnant - it's a medical problem which often needs appropriate medical treatment. The attitudes you are encountering are often born out of ignorance - and are a kind of "victim-blaming" - ignore them !

Q.My grandmother says that if I just pray and have faith, I will definitely conceive. How far is this true ?A. Believing in god can help you to maintain a positive outlook - but sheer will and blind faith won't overcome a physical problem like blocked tubes or absent sperms.

Q.My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal.A. Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential, which depends upon the sperm count. This can only be assessed by microscopic examination.

Q.My sister conceived only after 6 years of marriage. Does this mean I will also have difficulty conceiving ?A. If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.

Q.My doctor just did a physical examination for me, and he feels that the reason for my infertility is that my uterus is tipped backwards, and this prevents the sperm from swimming into the uterus. He is advising I have surgery to correct this problem. Should I go ahead ?A. About one in five women will have a retroverted uterus. If the uterus is freely mobile, this is normal, and is not a cause of infertility. This is not an indication for surgery!

Q.My husband says we should be having intercourse every day to achieve pregnancy. Is this true ?A. Sperm remain alive and active in woman's cervical mucus for 48-72 hours following sexual intercourse; therefore, it isn't necessary to plan your lovemaking on a rigid schedule.

Q.My friends say I should have sex exactly on the day I ovulate  to get pregnant. How can I do this ?A. Although having sexual intercourse near the time of ovulation is important, no single day is critical. So, don't be concerned if intercourse is not possible or practical on the day of ovulation.

Q.My sister in law is advising me to keep a pillow under my hips during and after intercourse . Will this increase my chances of conceiving ?A. Sperm are already swimming in cervical mucus as sexual intercourse is completed and will continue to travel up the cervix to the fallopian tube for the next 48 to 72 hours. The position of the hips really doesn't matter.

Q.My mother feels I am too tense, and that if I just relax, I'll get pregnant.A. If pregnancy has not occurred after a year, chances are there is a medical condition causing infertility. There is no evidence that stress causes infertility. Remember, all infertile patients are under stress - it's not the stress which causes infertiliity, it's the infertility which causes the stress!

Q.I just had a HSG ( X-ray of the uterus and tubes) done, and this shows my tubes are blocked. I've never had symptoms of a pelvic infection, so how could my tubes get blocked ?A. Many pelvic infections have no symptoms at all, but can cause damage, sometimes irreversibly, to the tubes.

Q.My doctor has advised me to take fertility drugs . I don't want to take them because if I am scared that if I do, then I'll have a multiple births.A. Fact: Although fertility drugs do increase the chance of having a multiple pregnancy (because they stimulate the ovaries to produce several eggs), the majority of women taking them have singleton births.

Q.My husband's sperm count varies every time we test it ! How do we determine what the "real" sperm count is ?A. Even a normal ( fertile ) man's sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications. There are other factors which affect the sperm count as well, all of which we do not understand.

Q.I have no problems having sex. Since I am virile, my sperm count must be normal.A. There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.

Q.I don't think infertility treatment should not be offered in India, because there are too many babies in this country already. Why should we exacerbate the population problem by producing more? In any case, IVF treatment is too expensive for India to be able to afford.A. The right to have children is a fundamental right of every human being and a very basic biological urge. Just because a neighbour has too many children should not deprive the infertile couple of their right to have their own.
IVF and related technologies are undoubtedly expensive, but, then, so is heart surgery. Yet no one objects when over Rs 1 lakh are spent to try to salvage the heart of a 70 year old man (whose life expectancy in any case is only about 5 years and is not extended by the surgery). Why then should medical technology not be used to help couples in their thirties (with their whole lives ahead of them) have their own baby? In fact, IVF is a much more cost-effective use of medical resources than a number of other accepted surgical procedures (such as joint replacement surgery or kidney transplants).

Q.My semen analysis report shows I have no sperm in the semen ( azoospermia ). Is this because I used to masturbate excessively as a boy ?A. Masturbation is a normal activity which most boys and men indulge in. It does not affect the sperm count. You cannot "run" out of sperms, because these are constantly being produced in the testes.

Q.My wife is frigid and does not enjoy having sex. Could this be the reason for her infertility?
A. There is no connection between sexual pleasure and fertility. Don't forget that even a woman who gets raped can get pregnant! And don't forget that the commonest reason women do not enjoy sex is because their husbands are unskilled lovers ! Maybe you should improve your sexual technique, and spend more time in foreplay and in pleasuring your wife.

Do you need more information on infertility ? Our book, Getting Pregnant - A Guide for the Infertile Couple, is a very valuable resource - and the full book is available online, free of charge!