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Infertile couples are often willing to move heaven and earth in order to have a baby. However, I find to my dismay that a lot of them do things which actually end up reducing their fertility !

1. They use lubricants while having sex which kill the sperm . Having "baby making sex" on demand is not much fun for either husband or wife - and it's quite common to have to use lubricants in order to be able to achieve intravaginal penetration. However, many couples will use lubricants such as K-Y jelly or saliva - both of which can kill the sperm ! If you do need to use a lubricant, please use a sperm friendly lubricant. The easiest one to buy ( and the cheapest one) is liquid paraffin. It' easy available OTC at a chemist - just look under the laxatives !

2. Timing sex. Most couples know that the wife is fertile for only a few days during the entire month. However, because they are quite clueless about what these fertile days actually are ( and do not whom to ask or how to calculate them), they often end up having sex on Day 14 ( which they remember vaguely from their high school biology class on human reproduction ( when they weren't busy pretending to be blase because they " knew it all" ; or were giggling and blushing) is the day when ovulation occurs and the egg is released). However, for many women, Day 14 can actually be an "infertile day " ( for example, for women whose cycles are 25 days or less) . Using the Free Fertility Calculator at www.myfertiletime.in will help you track your fertility ! Using OPKs can also help !

3. Not having enough sex. Many wives refuse to allow their husbands to have sex until their "peak fertility day". They believe that if they "store up the sperm" and then discharge this with a big bang, their chances of getting pregnant increase. Actually, this is not true. You cannot really store up the sperm - the count does go up when ejaculation is delayed - but it's the immotile sperm which increase - not the motile ones ! It's far more efficient t have frequent sex, as long as the sperm are going in the vagina !

4. Many infertile women still use BBT charting to try to track their fertile day. This is a big, big mistake. While BBT charting does provide useful evidence to the doctor , it's only retrospective evidence - it does not help to identify the fertile days, as the BBT raises only after ovulation has occurred ( at which time the cervical mucus dries up and sperm can no longer enter the uterus and swim up to the egg).

5. Not doing any homework. It still astonishes me as to how poorly informed many infertile couples are about the basics of baby making ! They will often waste time trying herbs and supplements advertised on dodgy websites to "boost their sperm count"; or take "fertility tablets" to increase their fertility. They will allow months to run into years before seeking medical attention - or even doing a basic ( and inexpensive) fertility workup, to confirm that everything this fine.

Many gynecologists advise ovulation tracking as the first line of "treatment" for infertile couples.
This seems to be sensible advise. You just have to go for vaginal ultrasound scans which help you time precisely when you ovulate. You have sex at this time, and since eggs plus sperm = baby, you get pregnant in the first cycle itself ! How can this fail - especially if you are young and all your test results are normal ?

Actually, the tragedy is that patients have very unrealistic expectations from follicle tracking ! The success rate , even in a perfect cycle , is only about 10 % ! Remember that human reproduction is not very efficient, and just timing sex does not help ( unless you've never had sex at the right time earlier !)

Doctors often forget the downside of ordering follicular studies. It can be very stressful because you need to take time out of your office work duties to get ultrasound scans done . Even worse, it can play havoc with your sexual life. We all know that Men are from Mars and Women are from Venus - and this difference gets hugely exaggreated when you are battling with infertility, because you and your partner seem to be on completely different planets as regards having a baby . Most men would rather let nature take its own course - and having sex frequently in order to have a baby sounds like fun ! They just cannot understand why baby lust seems to have taken over their wife's life - and why you are obsessed with stuff like eggs and ovulation and fertile times !

Doctors can be very casual about advising scans and they underestimate the additional stress this puts on the marriage ! Husbands hate having to have sex on demand - they feel they have become reduced to becoming sperm donors who have to perform when ordered to do so. This takes all the fun out of sex, and adds to the marital disharmony when the wife refuses to have sex on any day other than the day of ovulation because she wants her husband to "store up" the good sperm ! This can often be the last straw which breaks the camel's back , because infertility already stresses the couple. Also, having to lie with your legs up in the air for the scans can be quite embarrassing and humiliating - and having a doctor insert an ultrasound probe into your vagina on a daily basis can be a major turnoff !

My advise is that one cycle of ovulation tracking is enough. This can be useful because it teaches you to correlate the scan findings with your body's signals , such as your cervical mucus and ovulation pain . Scanning also allows you to make better use of OPKs and the free online fertility calculator in future cycles, because you understand what's happening to your body, so you do not have to medicalise baby making sex in future cycles and track ovulation discreetly at home !

However, if your doctor advises repeated follicular studies, please get a second opinion ! Otherwise you ( and your husband) are likely to get fed up and frustrated before getting pregnant !

Many patients do not understand the difference between embryo transfer and implantation and will often confuse these terms.

Embryo transfer is a simple mechanical process in which the doctor inserts the embryos into the uterus, using a catheter ( a plastic hollow tube).

This is usually an easy procedure which takes about 10 minutes to do. It is done by the doctor, and is usually performed using clinical touch ( where the doctor guides the catheter through the cervix into the uterine cavity with his sense of touch: or with ultrasound guidance).

In some patients ( for example, those with cervical stenosis ( a narrow cervix) or with an angulated cervix, the procedure may be technically challenging, and the catheter may not pass through the cervix easily. There are many ways of solving this problem , based on the difficulty and the doctor's experience and expertise. The doctor may use dilators or special catheter sets, which are designed to help him negotiate the cervical canal; or do the procedure under general anesthesia; or
do a ZIFT, thus bypassing the cervix altogether and transferring the embryos directly into the fallopian tubes.

Implantation, on the other hand, is a biological process , and involves three phases - apposition, adhesion and invasion. This is not in a doctor's control, and while most doctors are very good at making embryos in the IVF lab and then transferring them into the uterus, whether these embryos will finally implant or not is not in anyone's control.

Unfortunately, implantation is not an efficient process, whether done in the bedroom or in the clinic , and only about 30% of apparently perfect embryos will finally become babies. The commonest reason why embryos do not implant is that they have a genetic abnormality , and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which we still cannot screen for efficiently. However, as PGD technology improves, our ability to do so will also improve !

So if your doctors makes good quality embryos and transfer them into your uterus, this means he has done a good job. Now whether these embryos will become babies or not you will find out only after the dreaded 2 week wait !