Dear Doctor,

My husband and I have been trying to have a baby for years now. However, we have not been successful. We both got checked and it turns out we are fine. The doctor said it will happen and that this is normal. But so much time has passed already that I’m worried I will have the baby in my 40s. What am I doing wrong? Teta

Dear Teta,

How long have you been married and what is your age? Have any of you suffered from any sexually transmitted disease in past? Have you both been investigated in detail, including hormonal tests?

The fertility of a woman is dependent on balance of levels of estrogen and progesterone and time of ovulation. Usually, chances of conception reduce when one is nearing menopause, although it is not hard and fast.  If coitus is scheduled to approximate days of ovulation, chances of conception are high. One can estimate the day of ovulation by measuring the basal body temperature (BBT) as it is slightly raised during days of ovulation. This is done by measuring the mouth temperature by a thermometer, just before leaving the bed in the morning. The cervical mucus (secretion coming out from lower end of uterus and felt in vagina) also becomes thick and tenacious. If possible, one can go regularly to the sonologist, serial ultrasound of ovaries helps to identify the day when an egg is released.

Usually day of release of the ovum is said to be from the 14th to 21st day of a menstrual cycle. First day of bleeding is counted as day one. But this is variable. In some women it may occur as early as five to six days after and in some it may be delayed a little more.

Use of alcohol in either or both partners tends to disrupt the hormonal balance and causes difficulty in having a baby. Tight under pants, use of laptops on the lap, stress, are factors which can impair sperm production in men, thus affecting sterility.  All these should be avoided.

Any sexually transmitted disease in the past in either partner can block the tubes carrying the sperm or ovum, thus resulting in inability to conceive. This can be corrected by simple small surgery where the blocked tubes open.   Stress is also known to induce spasm and closure of the tubes, resulting in sterility.  Hence, a couple should be completely relaxed when having sex in hope of having a baby. Use of hormonal contraceptives can delay or impair fertility in a woman.

There are other medical disorders which can cause sterility. These include diseases of the thyroid, pituitary or adrenal glands. TB of the uterus is also one of the causes of infertility in women. But these conditions could be having other associated features. They can be detected by suitable relevant tests and are treatable.

                          Dr. Rachna   Pande is a

specialist in internal medicine.