It is estimated that 1 in 7 to 10 couples in India experience sub-fertility. It’s a common problem with identifiable male and female causes in up to 85-90% couples. Male factors contribute to about 30-35% of infertility cases. Both male and female factors coexist in 15-20% of couples. Female factors such as insufficient ovarian reserve, problems in ovulation, problems with fallopian tubes, endometriosis, PCOS etc are responsible for the rest.
Fertility treatments in India are often handled by doctors of various specialties including obstetricians, gynecologists, general physicians, urologists etc who have training in fertility management but are not specialists. Fertility specialists have experience as a doctor combined with core expertise in fertility which includes a post-graduate qualification in obstetrics and gynecology followed by a formal specialization in fertility management with a 1-2-year fellowship program.
Why it’s Done
About 85% of healthy couples achieve pregnancy with unprotected intercourse within one year. Couples who are unable to conceive beyond one year must get evaluated for medical conditions that may be affecting their chances of conceiving. A specialist can evaluate a couple to check for underlying problems through a detailed clinical check-up, scans and laboratory tests.
Some patients often find it easy to conceive (become pregnant) but may lose the pregnancy due to underlying medical problem. A fertility specialist attempts to identify the underlying medical problem in such cases through a detailed clinical history, ultrasound scans and laboratory tests.
Once a diagnosis is made a fertility specialist can plan the mode of treatment that would be best suited for a given couple. This could involve medical treatment of underlying disorders, surgical treatment in conditions such as fibroids or adhesions and specialized fertility treatment such as ovulation induction- timed intercourse (OI-TI), intrauterine insemination or assisted reproductive techniques (commonly known as IVF treatment).
How You Prepare
Fertility diagnosis and treatments involve the evaluation of both the male and female partners. It is advisable to visit the doctor together when possible for best results.
Most insurance programs in India do not cover infertility treatment. However, of late some insurance programs cover the procedures or provide top-ups which may provide coverage. Check with your insurance provider or corporate policy to see if your treatment can be covered by its provisions. Please reach out to the reception team at the hospital with a copy of your insurance policy/card as we can assist you in determining the coverage offered by your current policy.
Your medical records will have a lot of vital information for your fertility specialist, but they are only part of the picture. Your own recollections and facts are also very important. Take some time to write down and organize the following information ahead of your visit.
Your fertility specialist would gain insight into your condition through a detailed medical history and your past medical records. Please organise the following information to help the specialist to establish a diagnosis
Carry your previous medical records and laboratory test reports if available
List any medications, vitamins, herbs or other supplements you take. Include the dose and how often you take them
Any medical conditions that you or your partner may have.
Previous evaluations or treatments for infertility, if applicable
Age of first menstruation. Details about your cycle. Is it regular? How long is your average cycle? Is the flow especially heavy/light? Do you suffer from PMS or especially painful periods?
List details about your attempts to get pregnant. How long you have been actively trying to conceive. Frequency of intercourse.
Any family members who had faced difficulties in conceiving
It is advised to wear comfortable clothing on the day of the visit as you may need to undergo a gynecology check-up and ultrasound scan.
Do not feel nervous or hesitate to talk to your specialist about any questions or concerns that you may have.
Many tests in evaluation of fertility have to be timed with the menstrual cycle. It is best to consult a fertility specialist just before the expected start of your periods
What you can expect
First Visit:
You will need to arrive at the hospital 15-30 minutes before your appointment. The team at the reception would guide you on the process of registration and initiation of a medical record. They will then guide you to a fertility specialist.
The fertility specialist would talk to you to understand your problem better. The specialist may perform a gynaecology check-up and advice an ultrasound scan to visualize the ovaries, uterus and the fallopian tubes. The procedures are usually painless with little or no discomfort. The specialist may advice laboratory tests for you and your partner. Common tests advised include:
Female fertility tests: Tests for ovarian reserve, normal ovulatory function, hormones, diabetes, autoimmunity, thyroid disorders, blood counts etc
Male fertility tests: Tests for diabetes, thyroid disorders, liver or kidney disorders, complete blood count, hormones, tests for infections and semen analysis
Follow-up visit:
You would need to report to the reception at the hospital as per your appointment schedule. The reception would guide you and your partner to your specialist. The specialist would review the tests and advice you on the treatment course ahead. The specialist would discuss with you and your partner about the diagnosis (nature of the problem identified) and the possible treatment options. The specialist would guide you by answering your queries and help you and your partner in making a decision on the future course of the treatment.
You would be guided to a financial counselor who can help you in understanding the costs of the treatment options. The counselor would also help you with details on government programs, financial support programs or insurance coverage related queries to help you make your decisions.
Results/ Post Procedure
You would need to decide on the next course of action based on the medical advice given. The next steps could be
Lifestyle changes– Loosing or gaining weight, dietary changes, reduction in smoking or alcohol consumption, destressing techniques etc
Control of co-existing medical conditions such as diabetes, hormone imbalances, poor sperm counts etc
Further evaluation and Management of gynecological conditions such as fibroids, endometriosis, uterine abnormalities etc
Ovulation indication- Timed intercourse– A procedure where the specialist would prescribe medicines that stimulate ovulation and advice you on the right time to have intercourse to enhance your chances of conception
Intrauterine Insemination (IUI)– A procedure where the specialist would stimulate the ovaries with medicines to help patients to ovulate. The sperms would be washed, processed and placed into the uterus to enhance the chances of conception
IVF/ICSI– A procedure where the specialist would obtain multiple eggs by stimulating the ovaries and sperm to form embryos in the laboratory. The embryos are grown in the laboratory for 3-5 days and then introduced back into the uterus
What Are the Risks?
There is very little to no risk in undergoing an infertility evaluation at the right time. The procedures for scans and blood tests are relatively painless and minor. Fertility in both women and men declines with age. A delay in seeking help at the right time may make treatments more complex and expensive. A proper evaluation allows a couple to better understand problems and take the right course of action in a timely manner.
