In the majority of cases, the reason for the pregnancy loss can be attributed to the chromosomes of the fetus, which cannot be repaired and these pregnancies will almost always result in a miscarriage. The nature of such loss results in many couples choosing not to seek immediate help as they are able to conceive.
However, in around 10%-15% of couples, the reasons causing RPL (Recurring Pregnancy Loss) are treatable with the right team of experts who know the correct investigations to be done and provide specialised medical treatment and psychological support needed during this tough period.
Moreover, it is important to meet a specialist to determine the presence of any underlying causes of the miscarriage, since infertility may be experienced as both delayed conception and recurrent loss.

For most men, a 2-3 day break is ideal. This period gives the “sample” an opportunity to regenerate. Too “old” a sample raises the risk of poor motility, white cells, and other problems of “old” sperm. (An “old” sample would be one that is taken after more than 7 days of abstinence).

The seminal fluid consists of secretions from the testis, seminal vesicles and prostate. Producing a good volume or thick semen does not mean that the semen is normal. A semen examination should be done for sperm count, motility and normal forms.

A man’s sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:
– Heavy alcohol use
– Drugs
– Smoking cigarettes
– Age
– Environmental toxins, including pesticides and lead
– Health problems such as mumps, serious conditions like kidney disease, or hormone problems
– Radiation treatment and chemotherapy for cancer

A problem called varicocele. This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.

Other factors that cause a man to make too few sperm or none at all include a lack of Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.

Sometimes a man is born with problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

Restrictions:
– Heavy exercise like: aerobics, jogging, weight lifting are prohibited during ovarian stimulation until the pregnancy test results are known.
– Smoking / alcohol consumption should also be avoided during stimulation.
– If a lady is under some medical treatment, please consult the doctor whether prescribed medicine are safe during stimulation protocol. As some medications may interfere with the fertility medication.

Emotional issue:
As IVF cycle may be an emotional and stressful time for some couple, it may be helpful for a lady to talk to a supportive person like friend or a close family member. She can also take a help from counselor from the fertility clinic.

Some common medicines used to treat infertility in women include:
– Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
– Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is often used for women who don’t ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
– Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
– Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
– Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
– Bromocriptine (Parlodel): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.

Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.

Polycystic ovary syndrome (PCOS) is one of the most common causes of infrequent ovulation and irregular cycles in women. The exact cause is as yet unknown and in some cases may be genetic. In this syndrome, the ovaries produce an excess of androgens (male-type hormones) that prevent the egg from maturing normally, and the ovaries often have a multicystic appearance on ultrasound (hence the term polycystic ovaries) as a result of this arrest in maturation. Higher androgen production may also be associated with excess hair growth (hirsutism) on the face, chest, and abdomen. Because of fewer normal ovulations, women with PCOS often have difficulty conceiving. In addition, many patients with PCOS are resistant to the action of insulin and thus should be screened for diabetes.

Because ovulation is infrequent when PCOS is present, the uterine lining does not shed regularly. Women who don’t menstruate regularly are at increased risk for developing cancer of the lining of the uterus (endometrial cancer). This can be prevented by treatment with a medication known as Provera®, which will induce a menstrual flow. Provera® is a tablet taken daily for 12 to 14 days
every two or three months.

If a woman with PCOS wishes to conceive, ovulation can usually be stimulated with a medication known as clomiphene citrate. If this treatment is unsuccessful, injectable medications, called gonadotropins, may be necessary. Gonadotropins are very successful in inducing ovulation, though they are more often associated with multiple pregnancies than is clomiphene citrate.

Another treatment that has helped some patients is surgical “drilling” of the ovaries or wedge resection. This laparoscopic procedure temporarily reduces androgen production by the ovaries and may result in spontaneous ovulation or may improve the response of the ovaries to ovulation inducing medications.

As long as the periods are regular, this means ovulation is occurring. Some women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are “fertile” in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a 30 day cycle).

Day 1 is the first day you see a red flow, not just intermittent spotting.

Painful periods do not necessarily mean infertility. Regular painful periods are an indication of ovulatory cycles. However progressive pain before the menses or during the sexual act may signify endometriosis. Irregular menses should be investigated especially if you are obese.

Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman’s chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:
– Irregular periods or no menstrual periods
– Very painful periods
– Endometriosis
– Pelvic inflammatory disease
– More than one miscarriage

It is a good idea for any woman to talk to a doctor before trying to get
pregnant. Doctors can help you get your body ready for a healthy baby. They
can also answer questions on fertility and give tips on conceiving.

Many women are waiting until their 30s and 40s to have children. Age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman’s chances of having a baby in the following ways:
– Her ovaries become less able to release eggs.
– She has a smaller number of eggs left.
– Her eggs are not as healthy.
– She is more likely to have health conditions that can cause fertility problems.
– She is more likely to have a miscarriage.

Many things can change a woman’s ability to have a baby. These include:
– Age
– Smoking
– Excess alcohol use
– Stress
– Poor diet
– Athletic training
– Being overweight or underweight
– Sexually transmitted infections (STIs)
– Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

It is estimated that in about a  third of cases there can be an issue with the male however it is well documented that male factor infertility is on the increase worldwide. Female issues are diagnosed also in a third of cases, with a third combined factor, both male and female. 10% of cases are of unknown origin.