Basic counselling skills a gynecologist needs to master when seeing infertile couples

1. Dr Aniruddha Malpani, MD
www.drmalpani.com

2. Common questions
Which is the best time to have sex
?
Which is the best position ?
 Doctor, all the semen leaks out
after we have sex !

4. Medical gobbledygook

5. Who has the time ?

7. Encourage questions !
There is no such thing as a stupid
question
Answering questions improves trust
Enhances the doctor-patient
relationship
Create loyalty

8. How can I determine my
"fertile" period ?
Your fertile period is the time during which
having sex could lead to a pregnancy.
This is the 4 day period prior to ovulation
( release of a mature egg from the ovary).
Women normally ovulate 14 days prior to the
date of the next menstrual period.

9. Scheduling sex
The “fertile time” is 4 days before ovulation
After ovulation, the cervical mucus dries up and
the woman becomes infertile
Ovulation occurs 14 days before the next period is
due ( NMP – 14). Fertile time is NMP – 18, and the
next 4 days
www.myfertiletime.in

10. www.myfertiletime.in

11. Scheduling sex
Women can estimate their fertile time by
tracking their cervical mucus. The “wet
days” are the fertile days
Over- rigorous scheduling of sex is
counterproductive, because it takes the
“fun” out of sex.
Encourage patients to have sex as often as
they like , without scheduling it.
No BBTs !

13. Unconsummated marriages
Erectile dysfunction is very common
Takes time for patients to open up
Patients will not talk about this on
their own
Please bring it up proactively

14. Painful sex = Fenton’s
Vaginismus
These patients need lots of TLC !

15. My friends say I should have sex
exactly on the day I ovulate to get
pregnant. How can I do this ?
Although having sexual intercourse near
the time of ovulation is important, no
single day is critical. So, don't be
concerned if intercourse is not possible
or practical on the day of ovulation

16. My husband says we should be
having intercourse every day to
achieve pregnancy. Is this true ?
Sperm remain alive and active in
woman's cervical mucus for 48-72
hours following sexual intercourse;
therefore, it isn't necessary to plan
your lovemaking on a rigid
schedule.

17. My sister in law is advising me to
keep a pillow under my hips
during and after intercourse
Sperm are already swimming in cervical
mucus as sexual intercourse is
completed and will continue to travel
up the cervix to the fallopian tube for
the next 48 to 72 hours. The position
of the hips really doesn't matter.

18. My gynecologist has said I am
normal. Do I still need to get tests
done?
A routine gynecological examination
does not provide information about
possible problems which can cause
infertility, such as blocked fallopian
tubes or ovulatory disorders.
Do a systematic infertility workup.

19. My PCR is positive which means
I need anti TB treatment
Endometrial PCR for TB is
very unreliable
Too many false positives

20. My husband refuses to get his semen tested. He
says it is thick and voluminous which means it
must be normal.
Semen consists mainly of seminal
fluid, secreted by the seminal vesicles
and the prostate.
The volume and consistency of the
semen is not related to its fertility
potential
Sperm count can only be assessed by
microscopic examination.

21. My periods come only once every
6 weeks. Could this be a reason
for my infertility ?
As long as the periods are regular, this means
ovulation is occurring. Some normal
women have menstrual cycle lengths of as
long as 40 days. Of course, since they have
fewer cycles every year, the number of
times they are "fertile" in a year is
decreased. Also, they need to monitor their
fertile period more closely, since this is
delayed (as compared to women with a 30
day cycle).

22. My grandmother says that if I just
pray and have faith, I will
conceive.
Believing in god can help you to
maintain a positive outlook - but sheer
will and blind faith won't overcome a
physical problem like blocked tubes or
absent sperms.

23. My husband's blood group is B
positive and I am A negative.
There is no relation between blood
groups and fertility.

24. Could a psychological barrier be
the reason for our infertility ?
Unlike many other parts of your lives,
infertility may be beyond your control.
Don't blame yourself if you are not getting
pregnant - it's a medical problem which
often needs appropriate medical treatment.
Society’s unkind attitudes are often born
out of ignorance - and are a kind of "victim-
blaming" - ignore them !

25. My sister conceived only after 6 years of
marriage. Does this mean I will also have
difficulty conceiving ?
If your mother, grandmother or
sister has had difficulty becoming
pregnant, this does not necessarily
mean you will have the same
problem! Most infertility problems
are not hereditary, and you need a
complete evaluation.

26. My HSG shows my tubes are
blocked. I've never had symptoms
of PID, so how could my tubes get
blocked
Many pelvic infections have no
symptoms at all, but can cause
damage, sometimes irreversibly, to the
tubes.

27. My doctor has advised me to take
fertility drugs . I am scared that if I
do, then I'll have a multiple births
Although fertility drugs do increase the
chance of having a multiple pregnancy
(because they stimulate the ovaries to
produce several eggs), the majority of
women taking them have singleton births.

28. My husband's sperm count varies
every time we test it ! How do we
determine what the "real" sperm
count is ?
Even a normal ( fertile ) man's sperm
count can vary considerably from week
to week.
Sperm count and motility can be
affected by many factors, including
time between ejaculations, illness, and
medications.

29. All my tests are normal and my doctor says my
infertility is "unexplained" ! The very fact that I
cannot conceive means there must be
something wrong ! Is he incompetent ?
Yes, you are right. Unexplained
infertility is simply a confession of our
ignorance, and means that our
technology is not good enough to be
able to identify the problem.

30. I have no sperm . Is this because I
used to masturbate excessively as
a boy ?
Masturbation is a normal activity which
most boys and men indulge in. It does
not affect the sperm count. You cannot
"run" out of sperms, because these are
constantly being produced in the
testes.

31. My wife is frigid and does not
enjoy having sex. Could this be the
reason for her infertility?
There is no connection between sexual
pleasure and fertility. Don't forget that even
a woman who gets raped can get pregnant!
Maybe you should improve your sexual
technique, and spend more time in foreplay
and in pleasuring your wife.

32. My mother feels I am too tense,
and that if I just relax, I'll get
pregnant
If pregnancy has not occurred after a year,
chances are there is a medical condition
causing infertility. There is no evidence that
stress causes infertility. Remember, all
infertile patients are under stress - it's not
the stress which causes infertility, it's the
infertility which causes the stress!

33. Patients cannot afford IVF
IVF is expensive, but babies are
priceless !
In fact, IVF is a much more cost-
effective use of medical resources than
bypass surgery
Time is invaluable – and IVF saves
time

34. Not all IVF centers are equally
good
Give your patients the best chance of success. They
trust you – refer them to the best IVF clinic
Every IVF success is a feather in your own cap . Work
in partnership with IVF clinics, so you can create a
fruitful collaboration where everyone wins
Insist that the IVF clinic provide documentation and
embryo photos !

35. Who has the time to sit and talk to
patients ?
Create your own website and refer
patients to your website !
Your patients trust you
Local language
Youtube videos

38. Free App for Infertile Couples
www.myfertilitydiary.com

39. Internet Positive Patients need
Information Therapy !

40. www.drmalpani.com