In a couple who has been trying to conceive and are unable to do it, and the various factor which cause this has to be looked into. So the factors can be broadly divided into ovarian factors, where there is problem with an ovulation or impaired ovulation. There could be tubal problem where there is chance of tubal infections or tubal blocks could be the reason or there could be endometrial causes where there is failure of implantation where there is chronic endometrial implantation or endometrial tuberculosis, or hormonal imbalances like thyroid disorder prolactin imbalance or impaired glucose intolerance, where there is a failure in the implantation of the embryo. It can also be because of cervical factors, because of infection in the cervix or also the presence of antisperm antibodies it the cervix. Last is the semen factors. Semen analysis at the outset can be normal but they can be some subtle abnormalities like increased DNA fragmentation who are seen in individuals who are chronic smokers and also inn chronic diabetics with increased sugar levels.so these factors have to thoroughly have to be evaluated and the treatment factors can be individualized based on the cause. The cause has to be treated. If it is an impaired ovulation, then treat the factor, treat with ovulation induction medicine and see that they ovulate. If it is tubal problem then cannulate the block and try to release the block. If it is an endometrial factor then evaluate and treat the cause. If it is cervical infection, it has to be treated, or antibodies then we have to look at intrauterine insemination. If there is a sperm factor, that is if the DNA factor is higher, tell the patient to stop smoking and diabetics have a strict control of glucose level an also put them on a course of antioxidants for a period of 3 – 6 months, which might help in the control of DNA fragmentation. If all these factors are normal, then the next factors should be tried that is intrauterine insemination. In intrauterine insemination, the sperm sample is processed in the lab where the debris the seminal liquids are separated from the motile sperms and the motile sperms in a culture media are introduced into the uterine cavity. This improves the chances of pregnancy and overcomes the antisperm antibodies in the cervical mucosa. The maximum permitted cycles of IUI, intrauterine insemination is 6 cycles. After 6 cycles of IUI, but still, ovulation does not happen, then we have to consider the next option that is IVF. If the age factor is more than 35 years, we need not wait for 6 cycles, we can curtail it to 3 cycles. Even if after 3 cycles of IUI pregnancy does not occur, then probably IVF has to be considered taking into consideration her age factor and ovarian reserve. So we have to be faster in our approach in these individuals.

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Visit: MARVEL MULTISPECIALITY HOSPITAL, #153, 1st Cross, 1st Block, Beside Bandhan Bank, Koramangala 1st Block, 560034 Bangalore, India. Web : www.marvelhospital.in

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