Q: I am 31 years old and I have irregular menstruation. Sometimes, my period comes twice a month. Other times, I experience only spotting.
My husband and I are trying for a baby. His sperm count is low. We have tried in-vitro fertilisation (IVF) but it did not work.
How do I know when my ovulation starts? When is the best time to be intimate? Is there any other way to have a baby?
A: In general, menses come two weeks after ovulation if the ovum (egg) is not fertilised.
However, you can have periods without ovulation. This usually happens when the menstrual cycle gets delayed due to the lack of ovulation. But the menses that come would be so little that it results only in spotting. Your irregular cycles suggest that you may not be ovulating on a regular basis.
However, spotting may also signal a growth at the cervix or the uterus, or even an infection in the vagina or cervix. This can be determined by a pelvic examination followed by an ultrasound scan of the uterus to reveal any growths within the uterus, such as fibroids and ovarian cysts which may affect the hormones and result in abnormal cycles.
One specific problem is polycystic ovarian disease where there is no proper ovulation and the female hormone, oestrogen, is converted into male hormones.
To improve fertility in this situation, ovulation can be monitored using either a urine test kit or by serial ultrasound scanning of the ovaries.
Medication may also be used to encourage follicle formation (a bubble of water where the egg grows). When the follicle is big enough, it will rupture to release the egg within.
This process is caused by the luteinising hormone (LH). You can check for the hormone's presence by using a simple urine home-use test kit called LH kit or ovulation kit, which can be bought at a pharmacy.
Ovulation usually occurs 24 to 36 hours after the level of this hormone peaks.
For those trying to conceive, the first step is to find out whether you are ovulating. If you are, you can find out when it occurs by using the urine test kit.
An ultrasound scan can also be done to check on follicle formation. An injection can then be given to prompt an egg to be released.
After this, the egg has to "hop" into the fallopian tube to wait for the sperm to arrive. But if the tube is not patent (open), the sperm cannot reach the egg. The tube's patency can be checked by injecting a special dye into the uterus with multiple X-rays taken at the same time (hysterosalpingogram).
Otherwise, the doctor can inject saline into the uterus while it is being scanned by ultrasound.
Meanwhile, your partner could take medication to improve sperm quality. However, the formation of sperm can take about three months.
You may wish to consider artificial insemination or intrauterine insemination (IUI) using fresh or frozen sperm. In other words, the sperm can be collected over a period of time and kept frozen until the day of the procedure.
IVF would be the final resort, but as you have realised, it may not be successful.
Stress is a big culprit in many infertility cases. Some women get pregnant on their own after they stop all treatment. This may happen at a time when they are more relaxed and are not dwelling on the issue.
DR HENRY CHENG, consultant obstetrician & gynaecologist, Astra Women's Specialists, Mount Elizabeth Novena Specialist Centre
Brought to you by Astra Women's Specialists
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