I am Dr. Yuvakshi Juneja, Gynaecologist. I have been practicing for the last 30 years. My field of special interest is a high risk of obstetrics, infertility and gynecological problems like endometriosis, fibroids, ovarian tumors, etc. Today we will talk about infertility. When we say that the couple is having a problem in conception, after a period of 1 year they have been together and the woman is unable to conceive. This creates a social problem as well as for the couple who are desiring to become a parent. Once a woman is starting her married life, she always wants to have a baby. To not being able to conceive, put a tremendous amount of mental strain on the woman's mind as well as body. In today's world when there is so much pressure in all aspects of life like they get married late, so, this problem is expected to occur. But there is always hope for this couple if they will go in the right manner and get the right kind of help. I really feel bad for the woman who suffers from this problem. It is not easy for a couple to go for a treatment of infertility. My mind is always to help them as much as I can without putting too much of a financial burden. This couple first needs to be counseled and explained very well. They need to be explained how to go about it.
Therefore, first, they need to be counseled that they need to go a certain test for which they are adviced. In such cases, 30% problem can be with a woman and 30% with a man and 30-40% problem could be with both. After an initial workup which will be in the detail, simply a semen test of a male and after the reports, a female would be asked for certain tests and ultrasound evaluation. Clinical examination is required to rule out any medical disorder. History is very important for both partners. Then we can start with the treatment for these couples and once we have ruled out any problem like infertility in female because of ovulatory disorder function, hormonal imbalance, PCOS or it could be tubal factors secondary to some kind of infection, in our country especially tuberculosis. After this, we can start medical treatment for this couple after knowing the problems. Having tried some medical treatment and not getting ay success, then one must undergo further tests especially to test the woman for tubal factors.
That may require hysteroscopic and laparoscopic evaluation to evaluate tubes, ovaries, and the uterine cavity. Having tested for this, if we do not find any tubal factor, no significant problem like endometriosis then one can again start treatment. And if require one can offer IUI procedure and after about 4-6 cycles, we found that no success is there, then we will advise for IVF. But this should never be suggested initially. Because I have seen the couples who have hardly gone all the examinations and already has been offered for IVF which is not at all correct. Therefore, this treatment should be reserved only for those couples who have been completely evaluated and all other treatment modalities have been tried and have not been successful. To give hope is very important. But at the same time, one must speak realistic things and counsel them. So, they should know what they can expect from the treatment.