Dr. Kalpana

Hello, I am DR Vaishali Sharma. I am practising as a consultant Gynaecologist in South Delhi.

If you have any problem in conceiving naturally, then when to consult a gynaecologist. You should know that if your age is below 30-35 years then you can try naturally for one year. But if you are coming close to 35 years then I think that 6 months of natural conception is enough because you should not waste much time after the age of 35 years.

What are the options to increase the chance of pregnancy?

• The best thing is that you should go for Pre- conceptional counselling. But if you are not doing so then you should know that the best chance of conception is during the mid cycle, that is, if you have a cycle of 28-30 days then the best time for pregnancy is 10-16 days after your cycle. The number of days we are calculating here are from the 1st day of the cycle. So, this is the best time from which you can calculate naturally.
• The other thing is the kit that is available in the market to know what is the time of Ovulation, that is when the egg is released. So, these are the very commonly available in the market. YOu should use them from the 10th day of the cycle and then you have to use them daily, preferably in the afternoon period and you have to do the urine test yourself. If you find the two dark lines on it, that means you will be ovulating.
• Then if you find that you will not be able to conceive from these methods then you should go the nearby gynaecologist. She may advise you basic investigation from basic workup. For example a blood test, semen analysis and so on. And if the basic investigation area coming normal, then you are advised to have medicines. These medicines are roughly for 5 days. This is called Ovulation Induction. They basically increase the chances of ovulation and egg release. So, this thing you can try for 3-4 months but this has to be done under the guidance of Gynaecologist. We advise them to take 5 tablets during their periods. We call them from the 9th day of their cycle and perform an ultrasound to see whether the eggs are formed or not. Once the eggs are there and the appreciable size of 18mm is attained, then we give the injection to release the eggs. After this, we tell the patients that this is an appropriate time to try the conception. This way if the couple is not able to conceive within 6-8 months, then we advise them to go for either the injections, which will help in the formation of eggs.
• Or we advise them to go for IUI (Intrauterine Insemination). One most important point is that before suggesting IUI to the patient, the tubal testing is a must. That is usually advised HSG and SSG. In this way, we show that both the tubes are patent. In case there is a problem in semen or there is some problem with the male like the premature ejaculation or difficulty in performing. In such cases, we advise the patient to visit an endocrinologist. And the final option we give them is IUI. Through this, 50% of the patients are able to conceive in 6 months and another 50% of the patients are able to conceive in another 6 months. The cumulative success rate is come out to be around 75%.
• In case the patient is not able to conceive after injections and IUI then we usually advise them to go for Laparoscopy treatment. This is a diagnostic and therapeutic option because, in this, the woman has to get admitted to the hospital and we directly look through the Laparoscope, that is camera through which we are able to know if the tubes are blocked, any difference in the location, a relationship between the ovaries and the tubes. In this way, we are able to detect and correct it. It is a painless procedure and the woman has to admit in the hospital for 8 hours. THis is minor operation in which 2-3 stitches are there. BUt this is mandatory before proceeding further. After doing laparoscopy we are going to tell patients that the tubes are open and you can continue with the Ovulation induction and IUI. In that way, you will have the chances of pregnancy. And even after the Laparoscopic surgery, the tubes are blocked, then we suggest our patients for the IVF that is the test tube baby. If the tubes are blocked then IUI will not be helpful.
• IVF surgery is also advisable when the female partner is close to the age of 40 or so. After the age of 35 years, the quality of the eggs in the female ovary will decline sharply. So, sometimes the IVF is suggested directly to the patients in case ovarian reserves are poor.
• In case IVF test tube baby is advisable, then we have lot many options.

So, if you want to take an appointment, you can visit me at Asian clinic in GK-1 or you can consult me through Lybrate for the audio and the video call consultations.