Dear Doctor,

I have been trying to conceive in vain, yet this is my second year in marriage. Is there anything to worry about as I have done all the tests, yet they all confirmed I was fine?

Alice

You have not mentioned your age. Did you use any contraception before? There are multiple reasons for not conceiving.

Pregnancy occurs due to proper balance of the hormones estrogen and progesterone. If one has any hormonal imbalance due to disorders of the ovaries, thyroid or pituitary gland, it affects conception. Hormonal contraceptive pills or injections taken for few months continuously can affect fertility. Another common cause for infertility is blockade of the fallopian tubes. This commonly occurs due to pelvic infections or inflammation, secondary to sexually acquired infections. Adhesions can also form in the fallopian tubes due to trauma occurring in previous child birth or due to some intervention. Infertility can be due to abusive substances like alcohol and tobacco.

At times, the fault may lie with the husband. Absence of sperms or inadequate quantity of sperms can occur in a man due to childhood infections like mumps which affects the testes. Inflammation of the testes or blockade of the tubes carrying sperms can occur as sequel to sexually transmitted diseases and makes a man sterile. Putting a laptop computer over the thighs for long hours continuously, tends to raise scrotal temperature, impairing sperm production. Use of very tight underwear or nylon underwear by men has similar effect of reducing sperm production.

A couple may not have any problem physically, but they fail to conceive a baby due to wrong timing of coitus. Pregnancy occurs when intercourse is done during the fertile period of a woman, i.e. at time of ovulation. Ovulation occurs somewhere between 14th-21st day of menstrual cycle (counted from 1st day when menstrual bleeding occurs).

This can be assessed by recording basal body temperature or examining cervical mucous (discharge from lower end of uterus), which becomes thick and tenacious during ovulation. Serial ultrasound examination of the pelvis helps to pinpoint the time of ovulation, which can be utilized for intercourse or external interventions. Sometimes the pH of the vagina is too acidic preventing sperms to enter and fertilise the released ovum. This can be corrected by using alkaline douches.

If you are young, i.e. not more than 35 years, there is nothing to worry. In fact mental stress is also known to cause infertility by causing spasm, hence block of tubes in both partners. Remain relaxed and stress free, plan coitus around ovulation, with aid of ultrasound examination. The partner should also be investigated to detect any problem he may be having. With advancing age, chances of fertility reduce because of reduction in number of eggs released, reducing estrogen levels and many other chronic diseases as well. In that case, it is advisable to consult a gynaecologist and discuss other options of conceiving like artificial insemination or in vitro fertilisation, among others.

 Dr. Rachna   Pande is a specialist in internal medicine.