Let us define infertility as a couple not able to conceive at the end of two years of adequate opportunities.

Causes Anovulation: this means failure on the part of the ovary to produce ova (egg). Frequently the common reasons are cyst in ovary, hypothyroidism, hormonal disturbances, some sex chromosome disorders and advanced age. Tubal Factor: bilateral tubal obstruction accounts for nearly 10% of cases. Tuberculosis, other infections, appendix, or previous operations can distort and occlude the tubes. Uterine Factors: Tuberculosis, fibroids, or inadequately formed endometrium lining of the uterus. Cervical Factors: cervical mucous hostility can obstruct the accent of sperm, thus causing infertility. Coital errors, use of lubricants, improper timing, anxiety.

Investigations

• Tests for ovulation: Basal body temperature chart - the woman is asked to note the temperature every day in the morning at a fixed time. The shift, ie. raise in half or one degree fahrenheit indicates ovulation has probably occurred.
• Sonography - serial follicular growth measurement and documentation of reduction in size along with free fluid in POD indicates ovulation.
• Radio-immuno-assay
• Hormonal assay of serum progesterone on day 20 or 21 of the menstrual cycle can be of help. Other hormonal tests can also be done to check for lack of ovulation, like FSH, LH, Prolactin, TSH, etc.
• Endometrial biopsy
• Cervical mucous study - the amount and type of mucous as well as other properties are studied.
• Tubal Patency Tests
• Hystero-salphingo-graphy - a radio-opaque dye is pushed through the cervix. This dye is visualized while traversing through the uterine cavity and the spill inside the abdomen. X-ray films taken during the procedure can remain as documentation of patency.
• Sono-salphinog-graphy - this is a modified version of the above test, but done under sonography control.
• Laparascopy - though it is an invasive procedure requiring anesthesia and hospital admission, a lot of information can be obtained and this may change the course of theraphy.
• Uterine factor is assessed by using hystero-salphingo-graphy, sonography and hysteroscopy.
• Cervical factor is assessed by post-coital test, wherein the couple is asked to report after intercourse to examine the cervical mucous for the number of live sperms.

Dr. Shyam Kulkarni Gynaecologist Laksh-Deep Hospital