Obstetrics & Gynaecology

Q: What is Infertility?

A: Infertility is inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or inability to carry a pregnancy to term.

Q: Where do I start? What tests should I have?

A: There is no better place to start learning about basic test. Several basic tests for couples should be carried out to investigate the cause of infertile, such as baseline hormone studies, ultrasound, tube fallopian assessment and semen analysis.

Q: How long does it take to ovulate after the first positive result on ovulation kit?

A: It is most likely to ovulate between 12-48 hours after the first positive result on the kit and usually within 24-36 hours. There is not necessary to keep testing for your LH surge once you get the positive result.

Q: How long after HCG injection does ovulation occur and how do we know?

A: Ovulation occurs 36-40 hours after HCG injection. This scenario can be noted in IVF cases where eggs will be released in this time frame if they have not been retrieved.

Q: How long do sperm live after timed intercourse or after IUI?

A: Normal and healthy sperm live approximately 48-72 hours. Abnormal sperm may have a shorter life, which may vary according to sperm health.

Q: How long are eggs able to be fertilized?

A: Eggs are able to be fertilized for about 24-48 hours after ovulation. The older the woman, the shorter this time becomes.

Q: How long does it take for implantation to occur?

A: Implantation occurs about 5-10days after ovulation.

Q: How soon can I take my pregnancy test?

A: The earliest blood test can be done 14 days after ovulation. Home pregnancy test is advisable to take after 7 days of a missed period.

Q: How do you determine the first day of your cycle?

A: Day 1 if the first day you see a red flow, not just intermittent spotting. There is no universal rule for the cut off time for that date. Some centre use midnight, some use 5pm, but most often Day 1 is considered the first day full flow that begins before mid-afternoon.

Q: What should my uterine lining be at ovulation and at implantation?

A: As you approach your LH surge, it should be above 6mm, ideally between 8mm to 12mm. It is good to have a triple stripe pattern around the time of the LH surge and ovulation too.

Q: I have a day 2 FSH test done, and I am concerned about the results.

A: FSH test is to determine the status of ovarian reserve and this test is usually done simultaneously with Estradiol. If FSH is elevated (>10U/L), we would commonly confirm it with AMH and antral follicle count following ultrasound.

Q: How do we know if the sperm count is adequate for IUI?

A: Post washing count should be at above 15millions/mL in order to minimize the chances of IUI. Apart from that, sperm morphology and motility are also play an important roles to determine if IUI is suitable for couples.

Q: How big should my leading follicle be before I take HCG shot?

A: A lead follicle should be at least 16mm on HMG, it should be at least 18mm on a recombinant FSH like Gonal F or Puregon, and should be about 18-22mm on Clomid.

Q: How much do follicles grow each day?

A: Follicles grow 1 to 2mm a day while taking ovulatory stimulants and after the HCG shot.

Q: Will smaller follicles ‘catch up’ in time to release eggs?

A: Follicles generally need to be at least 15-16mm to contain fertilizable eggs. Although in rare cases, follicles as small as 14mm can still contain fertilizable eggs. If the smaller follicles are close in size to the lead, they may ‘catch up’ and release.
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