Question 1

What is the importance of haemoglobin electrophoresis in evaluating infertility?

Dr. Soma Singh · Accepted Answer

It is used as a screening tool before starting any infertility treatment, whether ovulation induction, IUI or IVF, to know whether the woman carries an abnormal haemoglobin such as haemoglobin S or C, or is a thalassaemia carrier. If she is found to be a carrier, the male partner needs to be evaluated too, because of the inheritance risk: if both partners are thalassaemia minor carriers, for example, there is a 25% chance of a child being thalassaemia major. Couples in this situation may need genetic counselling or pre-implantation genetic testing, screening embryos for these conditions before transfer.

Question 2

A married 28-year-old man reported two years of painless issues with sperm appearing in his urine, mostly at the start of urination, with no history of conception. How should this be managed?

Dr. Soma Singh · Accepted Answer

Sperm found in urine points to retrograde ejaculation, which usually follows a pelvic, perineal or urological surgery, or occasionally occurs in diabetes. Natural conception is not possible in this situation. The approach is to give the male partner an alkalinizing agent, then collect a urine sample immediately after ejaculation, centrifuge it and separate the sperm. Depending on the concentration recovered, those sperm can then be used for IUI or for IVF with ICSI. Any underlying epididymitis should be treated with antibiotics first, and the infection cleared, before using the sperm collected this way.

Question 3

What is the principle behind managing oligospermia, and is there a therapy for congenital azoospermia?

Dr. Soma Singh · Accepted Answer

For oligospermia, the approach depends on how low the concentration is: a genetic evaluation including karyotyping and Y-chromosome microdeletion testing is warranted, alongside correcting modifiable lifestyle factors such as smoking and alcohol, and giving antioxidants. Because sperm production takes about 90 days from formation to transport, semen analysis should be repeated after 8 to 12 weeks. If genetics are normal and the count improves, IUI is reasonable; if not, assisted reproduction is the next step. For azoospermia, a full hormonal evaluation is needed to distinguish hypergonadotropic from hypogonadotropic causes. A hypogonadotropic pattern can often be managed medically with gonadotropins. A hypergonadotropic pattern means the testes themselves have failed, and the approach then is surgical sperm retrieval, such as TESA or micro-TESE, followed by ICSI.

Question 4

Can you clarify the relationship between ovulation, menstruation and conception?

Dr. Soma Singh · Accepted Answer

In a natural cycle, a cohort of follicles starts to grow under the influence of FSH, but only the most FSH-sensitive one becomes dominant and ovulates while the rest undergo atrophy. After ovulation, the corpus luteum releases progesterone, fertilization takes place in the fallopian tube, and around the fourth day the resulting embryo enters the uterine cavity and implants. Through the same cycle, estrogen from the growing follicle has been building up the endometrial lining in preparation. If pregnancy does not occur, that lining sheds, and that shedding is menstruation. Menstruation happens precisely because pregnancy has not occurred; if it has, the lining is not shed.

Question 5

Given that couples are increasingly delaying pregnancy, how should a woman in her late 30s or 40s think about her real chances, and what can medically be done for her?

Dr. Soma Singh · Accepted Answer

Ovarian reserve varies a great deal between individuals at the same age, so egg number is not always the limiting factor after 35 or 40; egg quality is. As age advances, errors in the meiotic spindle mechanism increase, making chromosomally abnormal eggs and embryos more likely, which raises both implantation failure and miscarriage risk: roughly 12 to 15% up to age 35, rising toward 20% between 35 and 38, 25% between 38 and 41, and around 50% after 42. For a woman who wants to use her own eggs, pre-implantation genetic testing can screen embryos before transfer, provided she has enough reserve to reach a day-five blastocyst. Endometrial receptivity also declines with age, independent of egg quality, which is why even donor-egg pregnancies become harder to sustain after 44. Ovarian rejuvenation therapy using platelet-rich plasma is being tried and shows promise for some women, though the evidence is still accumulating.

Question 6

What are the complications and risks of embryo transfer?

Dr. Soma Singh · Accepted Answer

The procedure itself is not risky, but the implantation rate is only around 30 to 40%, which is why IVF success rates are not higher. Transferring more than one embryo to improve the pregnancy rate raises the chance of a multiple pregnancy, such as twins or triplets, well above the rate seen in natural conception. Placement technique also matters: pushing too much volume or placing an embryo too close to the fallopian tube raises the risk of an ectopic pregnancy, and in rare cases a heterotopic pregnancy can occur, where one embryo implants in the uterus and another develops in the tube, a complication seen almost exclusively with IVF.

Question 7

Can IVF be used for women in menopause who still want to conceive, and do they have any extractable eggs at that stage?

Dr. Soma Singh · Accepted Answer

A menopausal woman has no retrievable eggs of her own, but she can still conceive using a donor egg, which is a common and well-established approach even at a young age. After menopause the ovary is no longer producing estrogen, so hormones are given from outside to prepare the uterine lining, a donor egg is used, and the pregnancy proceeds and can be carried to delivery without issue.

Recent Advances in the Management of an Infertile Couple

Questions Doctors Asked Dr. Soma Singh