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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.

One of the most frustrating problems for infertile men is the fact that their sperm counts seem to vary all the time. On some days it is 5 million per ml; on others it drops to 2 million per ml; while on good days it goes upto 10 million per ml ! It's like the Sensex; as volatile; as hard to predict ; impossible to control; and variations in the sperm count cause as much stress as dips in the Sensex !

Remember that the testes are sperm production factories which produce billions of sperm daily. The efficiency of this factory is affected by many variables, many of which we still cannot identify ! Even in a normal healthy fertile man, sperm counts fluctuate all the time - and can vary all the way from 10 million per ml to 80 million per ml !

What makes a bad situation worse is the fact that many medical laboratories are not very good at testing the sperm. A semen analysis is a high-complexity test, but because it costs very little, many laboratories do it very casually, and provide erroneous results, which just cannot be trusted !

The problem of varying sperm counts is exacerbated in infertile men ! While the truth is that we do not know what causes the sperm count to drop ( or to rise for that matter), when the count drops, men often tend to blame themselves. Wives will often add to their guilt by blaming the drop on the usual culprits : a poor diet; unhealthy lifestyle; late nights; stress; or on smoking or drinking.

Many wives will nag their husbands to completely stop smoking, drinking or partying. It's very unlikely that social drinking or an occasional smoke affects the sperm counts and all these prohibitions just create unhappiness and bickering. Some men will deliberately throw away all their bad semen analysis results and just show the good results to their wife and the doctor
( and some continue to refuse to believe that a macho man like them can have poor quality sperm !)

We need to understand that we really know very little about sperm production - and there's very little the poor man can do to improve his sperm count ! In all honesty, there's very little the poor doctor can do either ! All we can provide are the standard platitudes - Eat a well-balanced nutritious healthy diet ; exercise regularly ; avoid stress; stop smoking; stop drinking; take vitamins; take supplements ; take these medicines ; and so on, but all these measures have very little effect on the infertile man's low sperm count !

Everyone loves advising infertile couples ! ( After all, if they've had a baby in their bedroom and proven their fertility , this makes them fertility experts, right ? )

The commonest advise is - Just relax ! Do not stress - do not take any tension ! This advise is even more pronounced during an IVF treatment cycle. If you want your IVF to succeed and the embryos to stick, you've got to "go with the flow" and not stress out. If you get too stressed out, your uterus will reject the embryos and they will not implant !

This is very unhelpful advise ! Of course there's a lot of stress in an IVF cycle - after all, no one wants to come to Dr Malpani to have a baby ! All my IVF patients are stressed out - and even the hyper ones do get pregnant ! It's true that patients need to learn constructive ways of dealing with this stress but to pretend that there's no tension involved is just being unrealistic.

The worry is that this kind of advise leads to blaming the victim. " You did not get pregnant because you were too stressed out ! Your IVF cycle failed ( what a cruel word) because you did do not relax enough !" This is hogwash. Don't forget that even a woman who gets raped ( whose stress levels must be through the roof) can get pregnant !

IVF patients understand the importance of optimism. However, many of them are very scared of getting their hopes up . They have been let down too many times in the past so far; and they are worried that if they become too optimistic, the crash down to reality will be much more painful if the cycle fails. This is why many patients keep their expectations low - so that they are better able to cope with failure .

Personally, I find a balanced approach the best option.

I request my patients to remember the Serenity Prayer -
God grant me the serenity to accept the things I cannot change;
the courage to change the things I can;
and the wisdom to know the difference.

Having a Plan B ready even before starting the IVF cycle can help you better cope with the IVF emotional roller coaster ride !

There's always a lot of anxiety when you have to go a doctor - and this is especially true when you have to do your tests to find out if you are fertile or not.

When your test results come back as abnormal, this is often your like your worst nightmare coming true ! The first response is often one of disbelief - maybe the lab mixed up my sample ?

Then start the mind games ! Oh God - does this mean I will never be able to have a baby ? Will we ever be able to fix this problem ? Will my spouse leave me if I cannot have a baby ?

Rule number one - please do not panic ! Remember that every problem has a solution - even if it may not be a very palatable one initially !

Please look at the silver lining - you are actually better off , because now at least we know what the problem is . The known enemy can be better than the unknown, because we can not focus our energies on bypassing the problem and finding a solution , rather than just groping blindly in the dark !

Also, remember that not every abnormality is clinically important. Many doctors will uncritically ask for a huge battery of tests for every couple to comes to them. Ironically, some patients are impressed by such a long ( and expensive !) testing protocol - wow - this doctor is very thorough ! He's doing so many more tests than the other guy did - which means he must be much better informed and more knowledgeable !

However, many of these so-called abnormal results are just normal variants, which are of no clinical importance. They are often found in normal healthy fertile couples as well ! They are just red herrings, which do not need any treatment at all ! Examples include: small ovarian cysts; small intramural fibroids and a positive TB PCR on endometrial biopsy. However, because doctors are so focussed on looking for problems, every time they come across an abnormality, their knee jerk reflex is to start treatment ! Sadly, many patients are also quite happy when the doctor "finds" an abnormality ! Aah - this guy is good ! He's finally found what the problem is ( which the earlier doctors missed because of their incompetence) - and now that he can treat it, I'll finally get pregnant !

However, often overtesting just leads to overtreatment - and to add insult to injury - the wrong treatment, because the doctor is "treating" a "problem" which has no effect on your fertility at all. Patients often end up wasting a lot of time and money - and then lose confidence in doctors - and in themselves ! They refuse to take the right treatment, because they've wasted so much on energy and money on the wrong treatment.

Also, this overtreatment can be dangerous and can actually reduce your fertility ! For example , unnecessary laparoscopic surgery to "treat" a small chocolate cyst can actually harm you, as normal ovarian tissue is also removed along with the cyst wall, thus reducing your ovarian reserve.

Use your common sense - and it's always a good idea to repeat the test before jumping to the wrong conclusion ! Meanwhile, do your homework and learn more about the test; what its variations are - and what they mean.

If you are having a hard time making sure you are on the right track, please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm , and I'll be happy to guide you !

During the luteal phase of the cycle, the corpus luteum produces the hormone progestrone, which elevates the basal body temperature ( BBT) . When the basal body temperature has gone up for several days, one can assume that ovulation has occurred. However, it is important to remember that the BBT chart cannot predict ovulation - it cannot tell you when it is going to occur !

In the past, doctors felt the basal temperature chart was a useful tool. It allowed the patient to determine for herself if she is ovulating as well as the approximate date of ovulation, but only in retrospect. Basal body temperature charts are easy to obtain and the only equipment required is a special BBT thermometer.

General instructions for keeping a basal body temperature chart include the following :

1. The chart starts on the first day of menstrual flow. Enter the date here.
2. Each morning immediately after awakening, and before getting out of bed or doing anything else, the thermometer is placed under the tongue for at least two minutes. This must be done every morning, except during the period.
3. Accurately record the temperature reading on the graph by placing a dot in the proper location. Indicate days of intercourse with a cross.
4. Note any obvious reason for temperature variation such as colds, or fever on the graph above the reading for that day.

However, the major limitation of the BBT is that it does not tell you in advance when you are going to ovulate - therefore its utility in timing sex during the fertile period is small. Interpreting the BBT chart can be tricky for many patients - rarely do the charts look like those you see in textbooks!

Also, keeping a BBT chart can be very stressful - taking your temperature as the first thing you do when you get up in the morning is not much fun. What is worse is that you start to let the BBT chart dictate your sex life. This is why though the BBT chart used to be a useful method in the past, it's utility is limited today - and newer methods are available which are more accurate are available. We advise our patients never to chart their BBTs - we feel they are just a waste of time.

Want to find out what your fertile time is ? You can use our free online fertility calculator to determine when you ovulate !

Many women these days are postponing having a baby in order to pursue a career. The good news is that while usually fertility does not decline too much until the age of 32, for some women the decision to postpone childbearing can prove to be one they bitterly regret later on. Fertility does decline as a woman grows older, and the problem is that it is not possible to predict the rate of decline for an individual woman. Most women are lulled into a false sense of security if they have regular period, because they assume that if their periods are regular, this automatically means that their egg quality if enough for them to make babies !

Unfortunately, this is not always true - and for some women, while their egg quality is enough for them to produce enough hormones to get regular periods, it may not be enough to make a baby ! Also, many women have very unrealistic expectations of IVF technology, thanks to all the stories of the over-40 celebs who have babies all the time ( often by using donor eggs, a fact which is very jealously guarded secret) !

How is an individual woman going to find out which category she falls into ?

Suppose you are 32 and want to postpone childbearing for another year because you have a very good chance of getting a promotion ? Is it safe to do so ? Or will this be something you will kick yourself for later on when your IVF doctor says - I wish you had come to me earlier ?

The bad news was that until now, there really was no very good test to check ovarian reserve. This often meant that most women had to just leave things upto destiny, which can be notoriously fickle.

The good news is that there is now a very good test to check your ovarian reserve !

The bad news is that most women are unaware of this test !

The good news is that this is a very simple blood test, which most labs now offer !

The bad news is that most family physicians and gynecologists are still unaware of this test and what it means !

So what's this test ?

This is a blood test for checking your AMH ( anti Mullerian hormone) levels. It can be done on any day of your cycle. The level correlates well with your ovarian reserve - the quantity and quality of eggs you have in your ovaries. Women with normal levels have good ovarian reserve; while those with low levels have poor ovarian reserve.

If you are more than 32 and want to postpone childbearing, I'd suggest you get this test done. If it's low, you might want to re-think your priorities. If it's normal, then it's fine to postpone childbearing, but do get the test repeated every year. If it starts dropping, this is a sign you might want to pay attention to your biological clock before it is too late !