Hello XXXXXXX,
Thanks for trusting us with your health query.
I have gone through your question in detail.
I would like to firstly guide you for your inability to conceive, since that is your major concern.

1. You are almost 30 years old now, and have been trying to conceive unsuccessfully for almost 2 and a half years. Please consult an Infertility Specialist in your city at the earliest. Almost 30 % of cases of infertility are cases of unexplained infertility, where no specific cause can be pinpointed, and ART ( assisted reproductive technology ) definitely helps such cases.

2. Your husband's decreased sperm motility could definitely be a reason, but as you have not attached the report, it is difficult to be specific about this. However, if the sperm motility is low, you should go in for procedures like IUI ( intra uterine insemination ) which will magnify your chances of conception.

3. You mentioned that fallopian tube testing was done. Could you please provide the details for the same ? As you previously had a miscarriage, chances of tubal damage are high. Also the cramping and problems you mention pre menstrually could indicate a possibility of endometriosis ( a disease where there is functioning uterine tissue outside the uterus - leading to pain, cramps, difficulty in urination or passing motions, painful intercourse etc ). This condition is diagnosed by a clinical check up by a gynecologist, and by ultrasound, and sometimes, a laparoscopy is required to confirm the diagnosis. In fact, I would recommend a laparoscopy and hysteroscopy to you anyways, because you require assessment of fallopian tubes and ovaries, which is best done by a laparoscopy. If the laparoscopy is fine, you can then proceed with treatment modalities like IUI, as I suggested.

4. The cyst is nothing to worry about at all. The report is almost one year old, and a cyst of this size ( 10 mm ) is called a follicular cyst / retention cyst. This happens when there is leftover cyst from one of the follicles ( eggs ) formed during the previous cycle. Nothing needs to be done for such a cyst, and it disappears on its own within a month or two. The cyst has no impact on fertility, and definitely would not cause cramps. It has no related with the burning urination also. I would advise you to go for a repeat pelvic ultrasound, which I am sure, would indicate no such cyst at present.

5. At certain phases in a womans menstrual cycle, the environment of the vagina predisposes to infections, and if you are experiencing burning micturition every month mid cycle, it could point to a mild urinary tract infection. Drink adequate fluids, get a urine microscopy and culture done, and maintain meticulous local hygiene during these days.

6. At times, with age, the incidence of premenstrual symptoms increases. The cramping and pain that you experience just before your periods could be plain pre menstrual symptoms also. To differentiate this, you require a thorough check up , ultrasound, and as recommended, a laparoscopy is ideal.

7. If you get these cramps before your periods, by no means does it mean that you have not conceived. The only reliable way to detect a pregnancy is a pregnancy test/ultrasound. Sometimes, even after implantation / conception, you might experience mild cramps.

8. Unless endometriosis is responsible for the cramps and urination problems, these two factors are not of concern for your fertility.

To summarize, Please proceed ahead as follows :
Please get your basic hormonal tests done ( complete blood count, blood group, Day 2 hormonal assays, AMH for ovarian reserve, Blood glucose and thyroid hormone testing ), a fresh semen analysis should be done. Also go for a repeat transvaginal ultrasound. I hope the ovulation has been confirmed by follicular monitoring already. Consult a gynecologist who specializes in Infertility and ART, get a laparoscopy done if not done already, and then quickly proceed to IUI / IVF as advised without losing time further.

Meanwhile, please take folic acid while you are trying to conceive, maintain an ideal body weight, take regular exercise and a healthy diet, and please try to eliminate stress and anxiety, as these negatively affect the reproductive hormonal axis.

Please DO NOT WORRY about the cyst at all, as it is insignificant, and the cramps and the urinary problems are also minor ones, which would not interfere with fertility.

Please feel free to ask for further clarifications anytime, I hope I have been able to clear your doubts.

I wish you all the best in your attempt .
Take care.

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Hi again XXXXXXX,
Your HSG report is essentially normal.
However, the HSG is not completely sensitive or specific for tubal disease.
A laparoscopy would be more detailed and reliable.
However, since you have already undergone HSG, you can go in for one or two cycles of ovarian induction with IUI, and then go for laparoscopy before deciding further course of action.
The results of IUI/IVF do depend on age, but more on the ovarian reserve ( capacity of the ovaries to produce mature eggs ), semen analysis and other complicating factors.
It DOES give positive results to women after 30 years of age.
Ovarian reserve is tested by AFC ( antral follicle count ) - already mentioned in your past USG report, and it is good, and by a blood test called AMH ( anti mullerian hormone ).
Plus, endometriosis etc can be diagnosed by laparoscopy.
So, if one or two cycles of IUI do not give you a positive result, you can proceed for laparoscopy.
Take care.

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Hello again XXXXXXX,
Its nice hearing from you, and thank you for your appreciation.

I would recommend a few names to you for Infertility consultation -

Dr. XXXXXXX XXXXXXX Jayanagar, Bangalore
Dr. XXXXXXX XXXXXXX JP Nagar Bangalore
Fortis IVF centre
Dr XXXXXXX Aggarwal

You would find the details and contact numbers of all these doctors easily on the internet.

After intercourse, if you are trying to conceive, do not immediately get up or use the washroom. Also avoid use of lubricants, vaginal gels or any medicated chemicals or products for cleansing of the private parts for both partners. Semen takes maximum a few minutes to ascend into the vaginal and cervical canal, however, try lifting your knees to your chest, and stay in this position after intercourse for atleast 15 - 20 minutes, before cleaning yourself.

It is natural for women / men to feel that semen flows out of the vaginal canal fast after intercourse. If your husband has no problems with ejaculation, do not worry. A few drops of semen is all that is required for conception, and once semen liquifies after a few minutes, you will feel it gushing out of the vagina. That is normal, and do not worry.

Riding a two wheeler has NO impact on conception.

Climbing stairs or any form of exercise in fact increases health benefits , which ultimately benefits all the body systems, including reproductive ones. It does not interfere at all with conceiving.

Please feel free to ask any further questions, and all the best with your attempts.

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Hi
Flooding me with questions is a compliment for me :)
Please go ahead, anytime, XXXXXXX.
As for your queries,

1. Increased belly fat , unless in grotesque amounts, does not interfere with penetration or intercourse. You would know best if you both achieve orgasm and satisfactory sexual activity. Regarding conception, yes, increased body fat in both males and females affects fertility, reproductive hormone secretion, ovarian function etc. You should aim at ideal BMI for both of you.

2. In a 28 day cycle, ovulation normally occurs around day 14. Being regularly sexually active ( daily or alternate day ) after Day 10 of period , for the next 10 days, ensures maximum chances of conception. Also, ovulation varies from month to month, so ideally I would advise regular ( alternate day ) sexual activity during the cycle.
3. Exercising daily definitely improves reproductive function in both males and females. The amount of exercise required depends on your current body weight and targetted body weight. A dietician would guide you better regarding the number of calories you need to burn per day, and hence the exercise form should be chosen based on that.
4. No specific fruit/vegetable/food is 100 % reliable to improve reproductive ability. A diet XXXXXXX in antioxidants ( XXXXXXX leafy vegetables/nuts/legumes/fresh fruits/whole grain cereals ), fibre, proteins ( yoghurt/dahi/paneer ) is helpful. Avoid starchy , fatty foods, carbohydrates, increased consumption of sugar, salt,ghee, maida , oil etc. Use olive oil/ sunflower oil for cooking and that too in minimum amounts. Increase intake of salads and XXXXXXX leafy vegetables, while reducing that of starch, rice, potatoes, sweets, snacks, packaged and processed foods. Have lots of fluids ( coconut water, lemon tea, XXXXXXX tea, home made soups and juices ). Avoid eating outside. Avoid binge eating. Eat small frequent meals at home, freshly made.
Take folic acid supplements.
5. An egg has a life span of 24 hours, while sperm can survive upto 3 - 5 days, and hence fertilization can occur anytime right from ejaculation ( sperm takes a few minutes to ascend into the vaginal canal ), upto 3- 5 days ( provided ovulation has freshly occurred. )
6. Ovulation kits are reasonably effective in predicting ovulation. However, you should rely on follicular monitoring to provide the most objective evidence of ovulation.

It is most important to stay stress free, exercise regularly, and follow the advice of a reputed Infertility specialist in your city.

All the best dear.

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