Age is the most important factor which affects a woman’s chances of conception and having a healthy baby. As a woman’s age advances her fertility starts declining since there is a reduction in the quantity and quality of the eggs in the ovaries. A woman’s fertility starts declining in her early 30s and this becomes more rapid after 35 and at age 40 and above there is a very minimal chance of conceiving. The problem lies in the fact that with advancing age there is an increased percentage of chromosomally abnormal eggs. These poor quality eggs results in poor embryo quality which reduces the chance of getting pregnant.

With advanced age there is a higher risk of pregnancy and birth complications. The chances of miscarriage are more in higher age group women. A woman of 35 and 40 have respectively 2.5 and 5 times higher chances of having a stillbirth than a women who is less than 35 years of age. Older women are much more likely to have a child with genetic abnormalities or birth defects. The best tests to go for to know of a woman’s ovarian reserve is blood for D2/D3 FSH, AMH and USG/TVS for Antral Follicular Count. AGE is something which we can never have a control on so if you are planning to have a baby start sooner rather than later when chances become dimmer.

PCOS also known as Stein Leventhal syndrome is the most common hormonal endocrine problem with at least 10% of women getting affected. Basically a woman having PCOS do not ovulate every month and hence have an irregular menstrual cycle and there are multiple cysts in the ovaries. So, the hardest thing for a woman with such a condition is the struggle to get a pregnancy which may take a longer time but is not impossible. If not diagnosed and managed earlier PCOS might lead to several medical complications like insulin resistance, high cholesterol, diabetes, hypertension and heart disease. Women with PCOS have a high testosterone level which leads to hirsutism, male pattern baldness and acne.

The most important thing a woman with PCOS can do is to manage her symptoms since there is no permanent cure. This can be done by leading a healthy lifestyle, eating properly and keeping active. There are also some medications (like OCPs, Metformin, Clomiphene etc) and supplements (such as D-chiro inositol, biotin, carnitine, green tea etc) which can be taken to control PCOS as well. Surgical intervention with laparoscopic ovarian drilling is also a treatment option which is done after careful selection and assessment of the patient. If you are diagnosed with PCOS and planning to have a baby its best to talk to a fertility expert sooner and discuss all the possibilities and fertility treatment options in order to get a safe and healthy pregnancy.

Fibroids or leiomyomas or uterine myomas are the most common non-cancerous growth in women which develops in and around the uterus or womb. The cause of fibroids is not very well understood but it does have a genetic predisposition. Early onset of puberty, obesity, hormonal problems may also be some other causes of fibroid. Some women with fibroids have no signs and symptoms, while some have severe pain, heavy and prolonged menstrual bleeding etc. There are a few women who complain of frequent urination, abdominal swelling, painful intercourse etc. The types of fibroids are intramural (within the lining of uterus/endometrium), subserosal (outer lining of the uterus), submucosal (inner lining/myometrium ) and pedunculated ( when subserous develops a stem).

Fibroids are diagnosed by an abdominal or transvaginal ultrasound and pelvic MRI. The size and the location of the fibroids are very important to determine whether they affect the fertility status of the woman or not. So, the treatment of fibroids is largely dependent on the size, site, age of the patient and the fertility status. Medications like GnRH agonist depots shrink the tumours, IUD insertion also is done in some cases. Surgical intervention both laparotomy and laparoscopy is done to remove the fibroids ( myomectomy) or sometimes the whole uterus(hysterectomy). There are some newer techniques called minimally invasive treatments like the UAE (uterine artery embolisation) or FUS (forced ultrasound surgery).

There are a number of hormonal imbalances which lead to infertility problems in women. Irregular menstrual cycles, absence of periods, lesser or heavier than normal periods are all indications of some abnormality in the FSH/LH and estradiol hormones. Excessive weight gain, abnormal hair growth, hair loss, acne etc are also due to hormonal imbalance. PCOS is an example of such a hormonal disorder which is one of the most common causes of infertility. Other examples of such imbalance are hypothyroidism, hyperprolactinemia, luteal phase defect or low progesterone and premature ovarian failure. There are a number of reasons which cause hormonal imbalance in our body; some of them are stress, poor nutrition, body fat, lifestyle choices, menopause, genetic predisposition etc.

Apart from the medicines (synthetic and natural) used for the treatment of specific hormonal disorders there are certain healthy lifestyle choices one has to make. This includes maintaining a healthy and nutritious diet, exercising regularly, stress management, supplements intake etc. If there is any suspicion of hormonal disorder in your body go for regular testing and checkups. It is vital to discuss the problems with your doctor and to plan the treatment with medicines and others in order to maintain a healthy hormonal balance. This will then result in achieving a successful conception and further sustenance of the pregnancy.

Fallopian tube damage is a major cause of female infertility accounting to almost 20% of all infertility cases. When there is block or damage in the tube the egg and the sperm cannot meet and so there is no fertilisation. Many women who are trying to conceive are not even aware that their tubes are damaged as there are no obvious symptoms. The most common cause for tubal damage is pelvic inflammatory diseases with gonorrhoea or Chlamydia, tuberculosis of the genital tract, endometritis/peritonitis/appendicitis and HIV infection. The various tests to diagnose tubal blockage are HSG, SSG/SIS, HyFoSy/HyCoSy and laparoscopy.

The only traditional treatment option for tubal blockage is tubal surgery to repair the damage as far as possible. The procedure is invasive and can have other side effects post surgery like ectopic pregnancy. The doctor will discuss several important factors before deciding to go for surgery and subsequent successful pregnancy. The most important ones being success rate post surgery, age of the female partner degree of damage and whether any other factors for infertility are present. A less invasive and more safer and effective solution in tubal obstruction is IVF or in vitro fertilisation. In case obstruction is associated with fluid collection in the tube (hydrosalphinx) then it is better to go for tubal clipping before IVF or else chances will reduce.

Uterine abnormalities are associated with infertility, ectopic pregnancy, recurrent pregnancy loss and various other obstetric complications. The investigations carried out in order to diagnose any uterine abnormality are HSG, SSG/SIS or ultrasound scan and also invasive procedures like the hysteroscopy and laparoscopy. Uterine abnormalities will include intrauterine adhesions as well as growths like fibroids and polyps for which the treatment is surgical removal with very minimal risk.

The other group of uterine abnormalities include the common congenital anomalies such as are arcuate uterus, septate uterus, bicornuate uterus,unicornuate uters, uterus didelphys and agenesis or hypoplasia. The diagnosis of such abnormalities are done mainly through pelvic examination, HSG/SSG, 3D ultrasound, MRI and endoscopies. Not all congenital anomalies need treatment but there are some conditions in which surgical correction is indicated. The surgery itself though is difficult and carries a good deal of risk. Septum removal in septate uterus, metroplasty and in some rare instance surrogacy is the treatment options.

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