Infertility is defined as when a couple having regular unprotected intercourse for a period of 12 months is not able to conceive. One in five couples have fertility issues and the incidence is on the rise. Stressful lifestyle and infrequent intercourse are among the main causes of Infertility in the urban population. The other causes of Infertility include male causes like sperm abnormalities (low count, low motility, abnormal morphology, absence of sperm), erectile dysfunction, ejaculatory failure, Varicocele, infections etc. Female causes of Infertility include ovulatory dysfunction (problems with egg release), decreased ovarian reserve, tubal block, thin endometrium, adhesions in the uterine cavity, uterine abnormalities, endometriosis, adenomyosis, polycystic ovaries etc. Sometimes there could be both male and female causes together and at times there could no cause identifiable when it is called unexplained Infertility.
A couple is initially evaluated for the possible causes. A baseline transvaginal scan done on day 2 or 3 gives us a lot of information. A semen analysis done after an abstinence of 2-8days will reveal semen parameters. Further hormonal evaluation of the couple, tubal patency tests, hystero-laparoscopy is done as and when required. We could start with natural cycle monitoring where serial scans are done to look at the follicular growth and rupture (ovulation) and the endometrial thickness and blood flow is evaluated. The next step is ovulation induction(OI) where we stimulate the ovary with tablets or Injections for the follicles to grow and release egg and the same is monitored through serial scans.The same cycles could include Intrauterine insemination(IUI) when there is mild male factor infertility, where the processed husband’s semen which is concentrated with good motile sperms is transferred directly to the uterine cavity. If multiple cycles of OI or IUI fail, then the last resort is In-vitro fertilisation (IVF).
It is the most common benign or non-cancerous tumour of uterus. It is seen in up to 30 - 35% of women in the reproductive age group of 15 to 50 years. It is a smooth muscle tumour which is totally oestrogen hormone dependent. So, it is seen only in the years where the lady has oestrogen, i.e between 15 to 50 years. It is a slowing growing tumour, usually not seen before puberty and usually shrinks after menopause. Its size could be as small as pea to as big as a football occupying the whole of abdomen.
These tumours can be silent to be incidentally picked up on ultrasound or could cause symptoms. Fibroids can trouble patients causing heavy menstrual flow, pain during menses, low back ache, heaviness or mass in the abdomen, subfertility or Infertility, early pregnancy losses or premature delivery. When the fibroid is very big, it can press on the bladder in front causing stasis of urine, incomplete emptying of bladder, repeated urinary infections. It can also press on the bowel behind causing constipation, incomplete emptying etc.
Causes of fibroid can be early menarche, late menopause, obesity, late conception or could also be hereditary