Health, according to the World Health Organization, is “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”.[1] A variety of definitions have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep,[2] and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still other factors are beyond both individual and group choices, such as genetic disorders.
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In-vitro fertilization or IVF is becoming increasingly common as a solution for parents who can’t conceive. But when is the right time for it?
Fertility issues can be exhausting and heartbreaking for couples who long for children. Apart from struggling to conceive, couples also have to deal with the stigma and psychological distress that comes along with physical fertility disorders. Therefore, it is always better to keep a tab on your fertility status or score and be informed on a timely basis. This will help in making crucial decisions that require time and deliberation, like opting to go for in-vitro fertilization (IVF).
A couple is said to be dealing with fertility issues if they are not able to conceive after 12 or more months of having regular unprotected sexual intercourse. The issue could be with the man or the woman or sometimes both.
What are the causes of infertility?
Your partner may face fertility issues due to low sperm count or mobility, which can be a consequence of factors like testicular infection, overheated testicles, hormonal imbalance, ejaculation disorders, genetic disorders, certain medications, STDs, exposure to radiation therapies, or lifestyle factors like obesity, alcohol consumption, etc.
In women, age is the most important factor of fertility. The higher the age, the lower the fertility potential. Other factors could be weight, diet, habits like smoking or caffeine consumption, any medical conditions like PCOS, thyroid disorders, STDs, problems in ovulation, or mental stress.
Tests for fertility
There are tests specifically for men and women. Based on these tests, doctors can determine your fertility status.
Here are some tests that your partner can get done:
1. Semen analysis to determine the volume and quality of sperm in the male partner. Usually, this is one of the first tests recommended to the male partner to determine the cause of infertility.
2. Other tests may include blood work (to check the level of hormones like FSH and testosterone), general physical examination, tests for sexually transmitted diseases and testicular biopsy to name a few.
Fertility tests for women:
1. Basic gynecological examination
2. Blood Tests (for checking the level of hormones like LH, FSH, thyroid, estradiol, progesterone, and AMH (Anti-mullerian hormone). These hormones indicate fertility in women. AMH testing is especially useful, as it helps in determining ovarian reserve
3. Ultrasound to check for conditions like PCOS, fibroids, and other reproductive disorders
4. Tests like HSG (hysterosalpingogram), which checks for tubal infection or blockage of fallopian tubes
5. Testing for STDs
6. There are other more invasive tests like hysteroscopy and diagnostic laparoscopy, which may be done in case there is an indication of serious reproductive disorders like endometriosis, blocked fallopian tubes, or in cases where the cause of infertility cannot be determined
How can the fertility score be evaluated?
After performing the necessary tests, doctors will chalk out your fertility potential. For example, in semen analysis, a normal sperm count ranges between 15 million to greater than 200 million sperm per milliliter (ml) of semen. Anything lower than that is an indication of low fertility.
In women, anti-mullerian hormone or AMH levels are important. AMH levels greater than 1ng/mL indicate a normal ovarian reserve. If AMH levels are lesser than 0.7ng/mL, it shows diminished reserve. Test scores like these help your doctor gauge your fertility level and they can guide you on the next steps.
When should you opt for IVF?
Not every fertility issue requires IVF treatment for conception. Your doctor will take into account the cause of infertility, your age, frequency of sexual intercourse, and fertility test results before recommending IVF. In mild to moderate fertility issues, drug treatments, intrauterine insemination (IUI), timely planned sexual intercourse could also work.
However, in the following cases, it is best to go for IVF treatment:
1. Severe tubal infection: Where the fallopian tubes of the woman are blocked;
2. Severe male infertility: When the sperm count is extremely low or even zero (azoospermia);
3. You suffer from a genetic disorder: If one or both partners suffer from a serious genetic disease and do not wish to pass it on to their child, IVF is a good option. With a technique called PGD (Preimplantation genetic diagnosis), the embryo is tested for genetic disorders before implantation;
4. Unexplained infertility: Where there are no obvious signs of any issue but pregnancy does not occur;
5. Endometriosis: A disorder where tissue that would normally line the inside of the uterus (the endometrium) grows outside it.
The last word
It is important to know your fertility status as early as possible, as it gives the couple time to get proper counseling from their doctor. The doctor will advise them not only on the treatment plan but also on certain lifestyle changes that will help them improve their fertility and realize their dream of parenthood.
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