ON YOUR PART....  Make sure your immunisations against rubella (R-vac) and Hepatitis B are complete and up to date  Take folic acid supplements (5mg a day ) to ensure proper development of the nervous system in the foetus  Reduce stress, by taking up yoga, meditation or Tai chi  Exercise for an hour a day even if both the husband and wife are of ideal body weight

At any given time, 12 per cent of married couples in India are trying unsuccessfully to have children. A majority of them have had arranged marriages. The pressure on the couple (especially the woman) to procreate is tremendous. If they haven’t conceived within 4- 6 months of marriage, many can be found in doctors’ offices, anxious and depressed.

A couple is considered relatively infertile only if they have been married at least a year, the woman menstruates regularly, the man has a normal sperm count, they have had regular and frequent intercourse during this period and still haven’t conceived. This automatically excludes couples who are together only every fortnight or once a month.

Women ovulate only once in 28 days (if they have regular cycles). Once the egg leaves the ovary, it survives for 12-24 hours. After ejaculation, sperms survive for 3-5 days. This means that there is a very small window in a month when pregnancy is possible. Work, travel, illness, social and religious functions all make it very possible for the “fertile period” to be missed completely. A person can have intercourse only on weekends for months on end and still manage to miss the “fertile days”.

It is possible to approximately calculate fertile days (the egg is released 14 days before the next period) and make sure they are not missed. The downside is that women do not function like machines and the length of their menstrual cycles can vary.

There are many specialised fertility centres all over India, which offer expensive and high tech solutions, intrauterine insemination (IUI) and IVF (in vitro fertilisation) being two that are much advertised.

Before attending one of these centres and embarking on an expensive journey, there are a few simple interventions that can be tried.

Check the BMI (body mass index) of both the husband and wife. Women with a BMI of 35 were found to be 25 per cent less likely to achieve a spontaneous pregnancy. If the BMI goes up to 40, the chances fall to below 40 per cent, despite regular menstruation. If the BMI is more than 25 in either partner, then the first thing to do is get it down with strict diet and exercise. Even before the weight begins to drop, the chemicals released by the body during regular and consistent exercise improves chances of conception by 50 per cent. Men with a BMI of 30 or more are also relatively infertile. Both partners need to stop smoking or using tobacco in any form and stop consuming alcohol.

A physician needs to be consulted without waiting for the mandatory year if you are an older couple (more than 35), if the woman’s periods are irregular, painful, there is endometriosis or symptoms of pelvic infection. In men, a visit to the doctor is recommended if there is a history of having been treated for diseases such as gonorrhea, prostate or cancer, or surgery for varicocele, hernia or hydrocele.

If reasons for infertility are analysed, in 33 per cent of the cases the woman has a problem, in 33 per cent it is the male and in 33 per cent no cause can be identified.

Men may not have children because their sperm count is low, the sperms are abnormal, there are ejaculation problems, over exposure to chemicals or heat in the workplace has harmed sperm, or as a side effect of hernia, hydrocele or varicocele, sexually transmitted diseases or previous cancer treatment.

Women’s infertility may stem from ovulation problems, polycystic ovaries, hormonal problems (thyroid, prolactin), abnormalities in the shape of the uterus or cervix, blocked fallopian tubes, endometriosis or premature menopause.

Evaluation for causes of infertility need to be done on a step-by-step basis after a complete physical check up by a doctor. Once a specific diagnosis is arrived, interventions can be suggested. Tests and treatment take time and can be expensive and uncomfortable. Even after a particular line of treatment is suggested and followed it takes a whole month (one menstrual cycle) before there is even a suspicion that the treatment may have been successful.

Switching doctors and clinics every few months because of anecdotes about success or turning to different systems of medicine will not ensure success. Instead, there will only be duplication of tests and procedures as each doctor attempts to give you a baby. Even in the best of hands success rates all over the world have not crossed 50 per cent.

Do not let that depress you. Some couples eventually become pregnant after they have actually “given up” on treatment. Also, there are other options available today like adoption and surrogacy.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in