Home / Couple fertility evaluation


Let’s understand natural fertility first !

A natural & healthy pregnancy is initiated when a chromosomally normal egg ( oocyte ) is ovulated from ovary during fertile period , enters open ( patent ) fallopian tube , gets fertilised with a healthy sperm. The resulting embryo then enters uterine cavity at blastocyst stage & implants in a receptive lining of uterus (endometrium )during the implantation window

Thin Endometrium

- In women with regular menstrual cycle usually single egg (oocyte) is released from ovary each month after 10-16 days of period . This process is known as ovulation.

- Cervical mucous & vaginal secretions become thin & start to increase in amount 5-6 days before ovulation with peak 2-3 before ovulation.

What is fertile period ?

- After release from ovary the egg remains suitable for fertilization for approximately 18 hours.

- While a healthy sperm may retain potential to fertilize oocyte for nearly 2 to 6 days from the day of ejaculation.

- Pregnancy is most likely to happen if sexual intercourse happens every 1-2 day, starting from 6 days before ovulation till the day of ovulation

- This time window between day 8-18 of period is considered fertile period.

What is the probability of natural pregnancy ?

- A fertile couple has best chance of pregnancy in first 3 month of trial which is in range of 20-37 %.

- Approximately 80 % couple conceive by the end of 1st year of trial for pregnancy.

- By the end of 2nd year, nearly 90 % couple conceive.

- Woman over 35 years & men over 50 years of age have lower chance of conception due to decrease in egg & sperm quality.

When to seek evaluation for fertility ?

It’s recommended to seek evaluation of fertility if you are suspecting any of the following –

1. Low ovarian reserve :
  • Age more than 35 year
  • Unexplained infertility of long duration
  • History of cancer treatment
  • Family history of early menopause
  • Any surgery done on ovaries
  • Known case of ovarian cysts
2. Ovulation problems :
  • It is suspected if period are shorter that 22 days or longer than 35 days
  • Most common reason being PCOD & advanced age.
  • Other issues can be related to hormonal imbalance of thyroid, pituitary – hypothalamus or adrenal glands.
3. Suspecting tubal block or distorted pelvic anatomy :
  • History of pelvic or abdominal infection like pelvic inflammatory disease (PID) , tuberculosis , appendicitis etc.
  • History of surgery in abdomen or pelvis
  • Known case of pelvic endometriosis – a condition in which the inner uterine lining(endometrium) is present outside the uterus.
  • Pain during intercourse or routine gynaec check up.
  • Severe pain during periods (dysmenorrhea).
4. Suspecting cervical ( lower part of birth canal ) problems :
  • Change in direction of cervical passage due to polyp , fibroid, stenosis etc.
  • Very thick cervical mucous which does not allow sperm to reach inside the uterus. It can happen when couple starts trying only after the ovulation is over since the cervical mucous thickens after ovulation.
5. Problem in sperm count :
  • Very low semen volume
  • History of infection in male genital glands
  • Hernia or any other inguinal ( lower part of abdomen ) surgery
  • History of trauma / torsion of testis
  • History of undescended testis
6. Problems in having normal sexual relationship ( sexual dysfunction ):
  • Vaginismus
  • Ejaculatory or erectile dysfunction
7. Suspecting problems in attachment of embryo ( Implantation issues ) :
  • Very less flow during period -it can be due to thin endometrium
  • Painful and /or heavy blood flow during period – it can be due to fibroids or adenomyosis.
  • Irregular spotting or heavy bleeding – can be due to endometrial polyps.
8. Consider meeting a fertility specialist now if :
  • Already tried for more than 1 year for women under 35 year of age Already tried for more than 6 months for women more than 35 year of age
  • History of abortion , lost pregnancy or any abnormal baby.
  • Family history of infertility , abortions or any abnormal baby
  • Already known case of any of the above discussed conditions
Hope this was helpful for basic understanding .The aim of this discussion is to make anyone with curious mind to understand these condition better .It is not equivalent to detailed in person individualised consultation .Please contact us if you want to understand your treatment options .