“No matter how old you are, it’s always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions on fertility, do some basic tests and give tips on conceiving.”

How often should we have intercourse for conception?

  • A woman ovulates once a month generally. Although not all cycles are ovulatory, that is, she may not produce an egg or it may not be released in all her cycles. Once a woman ovulates, the released egg is available for fertilization for 24 – 48 hours, after which it disintegrates. On the other hand once there is intercourse, the sperms remain alive for 72 hours in female body (in vagina, uterus & fallopian tube). So usually a female is in a fertile period for about 4 to 5 days around the mid-cycle of her period, which means from the day 11 to 16 in case of a 28 day cycle. If the couple is intimate during this period there are more chances of conception.
  • However, even if intercourse is planned during this period the chances of natural conception is about 15% in case of a normal fertile male and female. This rate decreases with the age, more so after they are above 30- 35 years old.
  • Human beings do not have intercourse only for conception. The orgasm and intimacy has a profound enriching effect on emotional as well as physiological effect on the couple. So the sex shouldn’t become too mechanical when a couple is consciously trying for conception. This may mount lot of mental stress and may affect the fertility outcome.

Do I need to have sexual intercourse 3-4 times on the day of OVULATION?

  • One time ejaculated semen in the vagina contains millions of sperms.
  • Only one fertile and motile sperm is needed to fertilize a female egg.
  • So it is not really necessary to have sexual intercourse 3-4 times on the day of Ovulation; and at the same time it is not even contra-indicated.
  • Most important thing is that the couple has to be mentally stress-free during the intercourse. Unnecessary compulsion to have multiple intercourses can build mental stress in both and performance anxiety in male.

Do I have to keep lying down after intercourse for semen to go inside the uterus? Do I need to keep a pillow below my back during and after intercourse to increase chances of conception?

  • During intercourse, millions of sperms are shed in the vagina. Sperms have a tail which helps them to swim towards the egg. The sperms cannot fall off from vagina or uterus as they swim through on the vaginal wall and uterine wall.
  • Gravity cannot make sperm fall out of vagina. Also the sperms do not come out when you walk or cough. So you don’t have to keep lying down after intercourse for semen to go inside the uterus.

If semen comes out of vagina after the intercourse when I get up; does it mean sperms haven’t gone inside the uterus and fallopian tube?

  • During intercourse, millions of sperms are shed in the vagina. Sperms have a tail which helps them to swim towards the egg.
  • The sperms cannot fall off from vagina or uterus as they swim through on the vaginal wall and uterine wall.

My husband doesn’t get desire for sex or at times doesn’t get erection on the day of ovulation. What to do?

  • The couple has to be mentally stress-free during the intercourse.
  • Unnecessary compulsion to have multiple intercourses & “sex on demand” can build metal stress in both and performance anxiety in male.

I get pain during intercourse at times. What could be the reason?

  • The commonest cause of pain during intercourse in females is “poor lubrication”.
  • For good lubrication, a female should be aroused properly.
  • There has to be adequate sexual drive in both partners. Proper counseling regarding this issue solves the probe in most of the cases.

Most of the time, I don’t get orgasm during intercourse. My husband doesn’t have any problem. Can this affect my fertility?

  • Orgasm is a psychological phenomenon.
  • Orgasm directly is not responsible in the natural process of Conception. It does not affect fertility. However organism is very important for good sexual health.

I have TORCH test positive. Is this a reason for me not conceiving?

  • TORCH test is for the diagnosis of antibodies against Toxoplasmosis, Rubella, Cytomegalo Virus & Herpes Virus (TORCH). These are primarily a group of viral infections.
  • If a female is suffering from any of the TORCH infections, she can have a pregnancy loss during acute illness.
  • Past illness of any of TORCH infections does not cause pregnancy loss. Due to previous illness the woman develops antibodies (IgG) against the infective virus and hence the TORCH test may be positive but this does not mean that she cannot conceive.

Tight underwear can impact a man’s fertility?

  • Sperms are present in testes and they mature in testes.
  • Testes are present in scrotum. The temperature of testes remains slightly lower than body temperature.
  • Spermatogenesis (sperm production) occurs when the temperature of the scrotum is lesser than body temperature. Higher temperature around testes can hamper sperm production. (e.g. Sauna bath more than 30 minutes at a time, tight undergarments for long hours, working in high temperature atmosphere etc).

Can stress reduce my chance of conception?

  • Stress affects many aspects of our life.
  • It impacts hormones, metabolism, mood, sex drive and appetite, so just about everything can be thrown out of order by too much tension.
  • There are studies which have shown that excessive stress may have an effect on fertility potential.

My best chance of getting pregnant is on day 14 of your cycle. Is it correct?

  • Usually the menstrual cycle of a women varies between 24 to 36 days in a young woman , that is she bleeds every 24 to 36 days. The bleeding lasts for 3 to 8 days per cycle on an average.
  • Ovulation happens around 14 days prior to starting of the next menstrual bleeding. So in case of 28 days of monthly cycle, the ovulation would be at around 14th day (+/- 2 days) and in case of 30 days monthly cycle the ovulation would be at around 16th day (+/- 2 days). Thus, the best chance of getting pregnant is on around 14 days prior to first day of menstrual bleeding in case of woman who has regular cycles.

Can taking birth control pills ruin my long-term fertility?

  • Although the oral contraceptive pills does suppress ovulation while you’re taking it, fears of sustained suppression are unfounded—once a woman stops taking the OC Pill, it no longer impacts her ability to get pregnant.
  • A review of studies from 1960-2007 found that after the first few months of going off the Pill, women’s fertility returned to normal, and that former OC Pill-takers were just as likely to get pregnant as women who had previously been using other forms of birth control.

Can obesity affect my fertility?

  • Several studies have linked obesity to low sperm count and poor sperm quality in men.
  • Obesity in women is a risk factor for anovulation (the absence of ovulation).One study that followed 47,835 couples found that when both partners were obese, their chances of having to wait longer than a year to conceive were nearly three times higher than couples with normal body mass indexes (BMI).
  • Another study in the journal Sterility and Fertility stated that being excessively underweight (a BMI of 17.5 or less) is linked to nearly five times the risk of infertility since women with too little body fat can stop ovulating and/or menstruating altogether.
  • The bottom line is “A good-for-you diet will not only promote a healthy you, but it will also increase your chances of getting pregnant”.

What is infertility?

  • Infertility by definition is failure to conceive and have a child after 1 year of unprotected regular intercourse. It can be primary or secondary infertility.
  • Women who are able to get pregnant but then have repeat miscarriages (Recurrent Pregnancy Loss) are also said to be infertile.

What is primary infertility and secondary infertility?

  • If a woman has never conceived then she has primary infertility.
  • If she has conceived earlier and has a baby or was able to carry her pregnancy till term either due to abortions or ectopic or any other reason and now she is having difficulty in conceiving again, it is called as secondary infertility.

How does pregnancy occur?

  • Pregnancy is the result of a complex chain of natural events which happen before and after the ovulation.
  • In order to get pregnant:

  • A woman must release an egg from one of her ovaries (ovulation).
  • The egg must go into the fallopian tube toward the uterus (womb).
  • A man’s sperm must reach to enter into the (fertilize) the egg into the fallopian tube from the other side of the fallopian tube.
  • After the egg is released, it moves into the fallopian tube. It stays there for about 24 hours, waiting for a single sperm to fertilize it. All this happens, on average, about 2 weeks after your last period.
  • Sperm can remain alive for 72 hours inside female body (in vagina, uterus or vagina). So it is not necessary that the conception happens only on the day of intercourse.
  • The fertilized egg must attach to the inside of the uterus (implantation). After implantation, the pregnancy starts.

Is infertility a common problem?

  • All over the world about 15% couples experience difficulty getting pregnant or carrying a baby to term.
  • Infertility includes inability to conceive as well as inability to carry a baby to term with live birth.

Is infertility just a woman’s problem?

  • No, infertility is not always a woman’s problem. In about one-third of cases, infertility is due to the woman (female factors). In another third of cases, infertility is due to the man (male factors).
  • The remaining cases are caused by a mixture of male and female factors or by unknown factors.

What causes infertility in men?

    Infertility in men is most often caused by:

  • Problems making sperm — producing too few sperm or none at all
  • Transportation of Sperms from Testes to Ejaculate
  • Problems with the sperm’s ability to reach the egg and fertilize it — abnormal sperm shape or structure prevent it from moving correctly
  • Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness, addiction, life-style or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man’s risk of infertility?

    The number and quality of a man’s sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include:

  • Alcohol
  • Drugs
  • Environmental toxins, including pesticides and lead
  • Smoking cigarettes
  • Health problems (e.g. Varicocele)
  • Medicines
  • Radiation treatment and chemotherapy for cancer
  • Age
  • Mental Stress
  • Unhealthy life-style (e.g. Metabolic Syndrome)

What causes infertility in women?

    Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

    Less common causes of fertility problems in women include:

  • Blocked fallopian tubes due to pelvic inflammatory disease (e.g. Genital Tuberculosis), endometriosis, or surgery for an ectopic pregnancy
  • Physical problems with the uterus (e.g.  Müllerian agenesis (absent uterus), Unicornuate uterus (a one-sided uterus), Uterus didelphys (double uterus).  Bicornuate uterus (uterus with two horns). Septated uterus (uterine septum or partition).  DES uterus (The uterine cavity has a “T-shape” as a result of fetal exposure to diethylstilbestrol), Arcuate uterus where there is a concave dimple in the uterine fundus within the cavity, Rudimentary uterus is a uterine remnant not connected to cervix and vagina and may be found on the other side of an unicornuate uterus.
  • Uterine fibroids –
  • They are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.
  • Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium).
  • It’s rare for fibroids to seriously hamper your efforts to get pregnant, and much depends on what type of fibroid you have. Less than three per cent of women seek help for infertility just because of fibroids.
  • Submucosal fibroids are the most likely type to affectconception & pregnancy. These fibroids can distort the uterus, and interfere with embryo implantation, whether by natural conception or IVF. This could be caused by reduced blood flow, making the lining of the uterus unfriendly to a fertilized egg.
  • If you know you have a fibroid and you’re having problems conceiving, see your fertility specialist. Your fertility specialist will first find out whether there are any other possible causes of your fertility problemand treat them.
  • Uterine Polyp
  • Numerous studies have shown that uterine polyps have a significant effect on fertility. Women who get their polyps removed have a much better chance of getting pregnant than those who do not have them removed.
  • The exact reason that polyps affect fertility is unknown, but it may be related to inflammation in the uterine lining. There is evidence that the body will start an attack against the polyp, which increases inflammation and makes it difficult for a fertilized egg to implant in the uterus. Uterine inflammation is strongly associated with polyps, which lends credence to this theory.

What things increase a woman’s risk of infertility?

    Many things can affect a woman’s ability to have a baby. These include:

  • Age (Fertility declines with increasing age)
  • Stress
  • Poor diet & Unhealthy Life-style
  • Obesity
  • Athletic training
  • Being overweight or underweight
  • Tobacco smoking
  • Alcohol
  • Genital Infectious diseases (e.g. Tuberculosis)
  • Recurrent Dilation & Curettage
  • Health problems that cause hormonal changes (e.g. PCOS, Hypothyroidism etc.)

How does age affect a woman’s ability to have children?

    More and more women are waiting until their 30s and 40s to have children. So age is an increasingly common cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

    Aging decreases a woman’s chances of having a baby in the following ways:

  • The ability of a woman’s ovaries to release eggs ready for fertilization declines with age. (Low AMH)
  • The health of a woman’s eggs declines with age.
  • As a woman ages she is more likely to have health problems that can interfere with fertility. (e.g. Chromosomal Abnormalities)
  • As a women ages, her risk of having a miscarriage increases.
  • Woman begins life with a fixed number of eggs. This number decreases with growing age. For a healthy young couple the chance for a woman to get pregnant in one menstrual cycle is about 20% when their sexual frequency is adequate.

How long should women try to get pregnant before calling their doctors?

  • Most healthy women under the age of 30 shouldn’t worry about infertility unless they’ve been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed. Couple should get themselves evaluated by a Gynecologist specializing in Fertility. The Fertility Specialist will do some blood tests & Pelvic Sonography and give them a fairly good evaluation of their fertility potential. Fertility specialist can advice them to take few early steps like reducing extra weight and life-style modification to enhance their fertility if needed.
  • In some cases, women should talk to their doctors sooner. Women in their 30s who’ve been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman’s chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.
  • Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible:

  • Irregular periods or no menstrual periods
  • Dysmenorrhea (Very painful periods)
  • Endometriosis
  • Pelvic inflammatory disease
  • More than one miscarriage
  • Increasing age can cause serious problems during pregnancy also.

How will doctors find out if a woman and her partner have fertility problems?

  • Sometimes doctors can find the cause of a couple’s infertility by doing a complete fertility evaluation.
  • This process usually begins with physical exams and medical and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, tests will be needed.
  • Finding the cause of infertility is often a long, complex, and emotional process. It can take months for you and your doctor to complete all the needed exams and tests. So don’t be alarmed if the problem is not found right away.

    For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.
    For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. A woman can track her ovulation
    at home by:

  • Recording changes in her morning body temperature (basal body temperature) for several months
  • Recording the texture of her cervical mucus for several months
  • Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If the woman is ovulating normally,
    more tests are needed.

    Some common tests of fertility in women include:

  • Hysterosalpingography (HSG): In this test, doctors use X-rays to check for physical problems of the uterus and fallopian tubes. They start by injecting a special dye through the vagina into the uterus. This dye shows up on the X-ray. This allows the doctor to see if the dye moves normally through the uterus into the fallopian tubes. With these X-rays doctors can find blockages that may be causing infertility. Blockages can prevent the egg from moving from the fallopian tube to the uterus. Blockages can also keep the sperm from reaching the egg.
  • Hysteroscopy is a procedure that involves insertion of a narrow telescope-like instrument (Hysteroscope) through the vagina and cervix into the cavity of the uterus (endometrial cavity). The uterine cavity is then distended with fluid and visualized.
  • Laparoscopy: During this surgery doctors use a tool called a laparoscope (telescope-like instrument) to see inside the abdomen (Lower part of the Tummy). The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.

How do doctors treat infertility?

    Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery.

    Doctors recommend specific treatments for infertility based on:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and woman
  • The overall health & life-style of the partners
  • Preference of the partners
  • Doctors often treat infertility in men in the following ways:

  • Sexual problems: If the man is impotent or has problems with premature ejaculation, doctors can help him address these issues. Behavioral therapy, sexual counseling and/or medicines can be used in these cases.
  • Too few sperm/ poorly motile sperms:If the man produces too few sperm or poorly motile sperms due to varicocele, sometimes surgery can correct this problem. In other cases, doctors can surgically obtain sperm from the male reproductive tract. Stress Reduction, obtaining ideal weight (treatment of Obesity) & life style changes significantly improves the man’s fertility potential. Antibiotics can also be used to clear up infections affecting sperm count.
  • Various fertility medicines are often used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the risks, benefits, and side effects.

    Doctors also use surgery to treat some causes of infertility. Problems with a woman’s ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery.

    Intrauterine insemination (IUI) is another type of treatment for infertility. IUI is known by most people as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

    IUI is often used to treat:

  • Mild male factor infertility
  • Women who have problems with their cervical mucus
  • Couples with unexplained infertility
  • Poorly timed sexual intercourse due to busy life-style

What is assisted reproductive technology (ART)?

  • Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman’s body, mixing them with sperm in the laboratory (ICSI), and putting the embryos back into a woman’s body.

How often is assisted reproductive technology (ART) successful?

    Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

  • Age of the partners
  • Reason for infertility
  • Fertility clinic
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen
  • ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

    Common methods of ART include:

  • In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm or poorly motile sperms or both. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs (Ovulation Induction). Once mature, the eggs are removed from the woman (Oocyte Pick-up) by small telescope passed through vagina. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman’s uterus.
  • Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
  • ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm (sperms from another man), or previously frozen embryos as per the individual need of the case. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby.

My mother told me not to eat hot food when I was planning and now during my pregnancy too she told me to avoid eating papaya and chicken? Can this harm my baby?

  • Many mothers and mother in laws tell their daughters to keep away from warm/ hot (garam) foods. It is nothing but a myth that eating food like papaya, pineapple, chicken, chillies and eggs may be heat inducing and cause problems in conception and even abortions. Infact there is no proof to say the same. People in the Western countries have been eating these food and getting pregnant as well as continuing a healthy pregnancy to term.
  • Papapya seeds contain oxidosins which can trigger contractions in the uterus. But this does not mean that it has to be completely excluded from the diet.
  • Eating everything in moderation is the key to a healthy pregnancy.
  • Chicken and eggs are a rich source of protein and hence beneficial during pregnancy. They help in the growth of the fetus.
  • Some people also advise to avoid red meat, but this is generally as it is difficult to digest and may cause bloating and constipation, but it is not harmful to the baby.

I just came to know that I am pregnant. Should I stop all exercises? Will it harm my baby if I continue with my exercise?

  • It is a myth that a pregnant woman must only rest and not do any physical activity. In fact moderate activity is essential for the growth and wellbeing of the baby as it increases the blood supply to the developing baby.
  • Pregnant women should continue doing moderate exercises in the form of walking, breathing exercises and yoga etc. However one must first talk to her treating obstetrician and then only start or continue with these activities as every patient is different. Any kind of strenuous activity must however be avoided.

Can I travel during my pregnancy? I am a working lady and travel by train?

  • Generally travel by train and four wheelers is fine from the first month to the seventh month, provided there is no complication in the pregnancy. Your obstetrician will examine you and will be the best judge for your case.
  • It is better to avoid / plan travel by two or three wheelers as the ride may be very jerky.
  • Before travelling by air always consult your obstetrician as the air pressure changes during takeoff and landing may affect your pregnancy.

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