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  It is a couple-oriented one-day program, where the couple presents their history and previous investigation reports if any are seen.

  They are then told about their physiology of ovulation, normal conception. Given inference is passed on to the couple as what may be the cause for infertility.

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  Generally, we do not repeat the investigation done in any centre if the result is from within recent 6 months duration. If not explained to the couple, why the certain test has to be repeated, the cost of it, how the result may help in the treatment.

  If Semen analysis is done, not in an ART center, but outside the lab where technician’s changes every day, We prefer to repeat it in our center. For the above reason, we advise the couple to come on the 2nd day of a natural cycle (which means the female partner would not have taken any medicines for withdrawal bleeding). The blood is taken on the 2nd day in the morning for the hormone profile and to rule out infections, a base line pelvic scan is done for the female partner. Semen analysis of husband is done and they are advised for further investigation if necessary or told about the treatment of choice for them.

  Any treatment that is decided for a particular couple. The treatment is explained, the duration of treatment, cost of treatment and the outcome.

  Certain women will need hysteroscopy or laparoscopy according to the findings in the pelvic scan. Complete endoscopic work is available here and the woman can undergo the surgery if needed.

  Following a laparoscopy, if the male partner is normal, 3 months time is given for natural conception. Failing which the woman may be given medicines to produce the number of eggs and attempt pregnancy naturally or do intrauterine insemination of husband’s semen after sperm wash.

  IUI is generally advised for cervical hostility or borderline seminal parameters. This can be attempted 3-6 cycle if the woman is very young. In normal cases where both partners appear normal after sufficient trial only ART is suggested.

  In some patients where the male partner has been treated for low sperm count and motility but no improvement is seen, we advise them to proceed directly to ICSI, a test tube baby procedure. Woman with blocked tubes which cannot be corrected, IVF is advised. Men with Azoospermia where the cause is due to congenital absence of Vas deference, direct aspiration of sperm from the epidymis and injecting the sperms into the eggs are advised. ART can be attempted three times depending on the condition. The success rate still remains within 50 percent and the failure is due to vary many causes.

Authored By Dr. N.P. Vijayalakshmy MBBS, M.D., D.G.O

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