Is conception easier for 30 years female and 35 years male? - Dr. Sangeeta Gomes

Pre-Conception counselling and basic infertility work up is needed for a couple that is 30 years female and 35 years male especially if they are planning to postpone pregnancy, the couple should approach the doctor if not able to conceive within 6 months of regular intercourse of good frequency. Now factors essential for conception are healthy sperms with good motility, ovulation occurring normally, patent fallopian shoes so that the outside can be picked up by the fimbria end of tube. The endometrium should be receptive for implantation of fertilized egg, the Corpus luteum should function adequately. Conception depends upon both male and females factors, male is directly responsible for infertility in 30 to 40% cases, females about 40 to 55% cases, both are responsible in 10% cases, remaining 10% remains unexplained, investigations for the male detailed medical history of sexual transmitted diseases, mums, orchitic diabetes, diabetes, recurrent upper respiratory tract infection, bronchiectasis, history of inguinal hernia repair, history of testicular surgery, any chemotherapy taken in the childhood, Sexual history erectile dysfunction, social habits like smoking alcohol or substance abuse. Through physical examination is done examination of genitalia is also done, investigations ask for blood investigations with sugar and thyroid, Semen analysis is done after 3 to 4 days of abstinence, the semen is checked for the count motility, morphology and the presence of fructose. Additional test like follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, scrotal scarring and curia typing is asked for in certain cases. Semen culture sensitivity to look for any infection, now the falls in the male can be defective spermatogenesis; ideally it takes 72 days for sperm to form and additional 12 to 20 days to travel to epididymis, if there is abstraction of inference duct, failure to deposit the sperm high in the vagina, absence of fructose and seminal fluid. Now coming to the causes of female infertility, ovulation disturbances in 30 to 40% cases, tubal diseases in 25 to 35%, uterine factors in 10%, cervical factors in 5 %, pelvic endometriosis in 1 to 10%, investigations of female taking detailed history of tuberculosis, sexually transmitted diseases, pelvic inflammatory disease, diabetes, previous abdominal or pelvic surgery which can cause spiritual edition, menstrual history whether the period is less or more, history of previous abortions as this could cause damage to the uterine inner valve of the tubes, use of intrauterine contraceptive device, Sexual problems like loss of libido and dyspareunia. The detail examination of the individual is done like height, weight, BMI if there is any hirsutism, acne looking at the secondary sexual characters. Gynaec examination is done to look at the vagina, cervix and uterus, certain blood test which are asked for are follicle stimulating hormone, luteinizing hormone, prolactin, thyroid, fasting blood sugar, haemoglobin and anti mullerian hormone, these are usually done within the first 3 days of period in the fasting state early in the morning. Talking about anti mullerian hormone, it gives a clue about ovarian reserve about how fertile the lady is whether she has time to postpone our pregnancy or she should act quickly and plan her pregnancy. Diagnosis of ovulation is done by various methods like using ovulation kit, basal body temperature method, cervical mucus stress test, serial follicular scan using ultrasonography to check the size of the follicle and endometrium thickness. Diagnosing tubal problem is done by a test called hysterosalpingogram or Sono hysterosalpingography, laparoscopy and chromo tabulation also can be done to look at the tubal problems and other pathology, for uterus problems hysteroscopy can be done is a procedure where we introduce a camera into the uterus and be visualised to look it there's any fibroids is there any polyp, septum or any additions.