Female Infertility
Female factor contributes to one third of the total infertility patients. The problem could be either in the tubes, ovaries or unexplained. Systematic evaluation is done which includes a scan, tubal evaluation with the help of HSG or hystero-laparoscopy. As are the causes found, so are they treated accordingly.
- Tubal Factor – Tubes are found either blocked or non-functional. They can be either operated upon or can be bypassed with the help of IVF. This decision is done on case to case basis depending upon the severity of damage, age of the patient and any other associated infertility factors. Once the tubes are surgically opened, six months waiting period is given. If it fails, IVF can be done as an option of last resort.
- Ovulatory Disorders – Ovulatory disorders can be either poly-cystic ovaries, ovarian failure or hypo-gonadotrophic hypo-gonadism. Hormonal evaluation is used to clarify the diagnosis and treated accordingly. Polycystic ovaries needs egg formation which may be simple but if it fails it needs aggressive management in the hands of an expert. Ovarian failure needs donor egg.
- Endometriosis – It is a disease of the pelvis in which it is unable to clear off the retrograde flow of menstrual blood. Individualized treatment of the patient – surgery / IVF or both is done on case to case basis. Multiple surgeries do not good. Decision to do IVF sooner prevents recurrence.
- Fibroids – All fibroids do not need surgery. Only the ones pushing the cavity need surgery. So a detailed transvaginal scan from an expert makes the picture clear. Surgery can be done laparoscopically on day care basis with minimum risk. Post-surgery whether one needs to wait for spontaneous conception or IVF will also depend on each case individually.
- Adenomyosis – Adenomyosis is a disease of the uterus where it becomes bulky and enlarged. Mostly it is suppressed with medicines but sometimes in very large uterus debulking surgery may be required.
- Thyroid Disorders – Universal screening of all patients is done. Thyroid disorders may be associated with unexplained infertility, recurrent pregnancy loss and obstetric complications like preterm labour if left untreated. It needs to be amicably handled by an expert.
- Hyperprolactinemia – Prolactin levels are also checked in all infertile patients. Males suffering from hyperprolactinemia may present with erection and ejaculatory disorders. In females if the levels are more than 100, brain tumors need to be ruled out. At lower levels than 100 it may be associated with ovulatory disorders and luteal phase defect.
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