Brief Answer:
As many as you can up to 24 hours after ovulation

Detailed Answer:
Dear XXXX,

I hope when you took the injection (Inj. hCG) for follicle rupture to effect the egg release (ovulation), the follicle was well mature and having size between 18 mm and 21 mm. Usually, the ovulation results within 4 to 24 hours after the hCG injection. Hence, we advise frequent sexual relation after the injection - how many depends upon the physical stamina of the couple.

The egg has a life of 24 hours and the sperms are active for 72 hours. Hence after the ovulation has resulted, intercourse up to 24 hours will be useful for bringing about the fertilization of the egg. The intercourses performed up to 72 hours prior to the ovulation also has capacity to cause conception. You already have couple of intercourses in the most fertile period.

Ultrasonography confirmation of follicular rupture suggesting ovulation would be helpful. After the follicular rupture, have as many intercourses as possible for at least 24 hours.

So there is no specific advice as to what time you should have repeat intercourse today. As I have already informed you, any number of intercourses up to 24 hours after the ovulation has resulted will be useful.

For any more information or query, you are most welcome to ask me, XXXX. You may post a good review with 5 stars rating for me.

Dr. Nishikant Shrotri

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Brief Answer:
Not an issue

Detailed Answer:
Dear XXXX,

The total amount of semen deposited during one intercourse is about 5 ml, of which less than 2 ml may flow out after intercourse. If the penis is withdrawn while it is hard, it will act as a piston in a syringe and will suck more semen out of vagina. Hence, the penis should not be actively pulled out of vagina after intercourse. When it is placid, it will slide out of vagina when woman separates her legs apart, till that let him lie on your body.

The semen is ejaculated in different phases. The first part of the semen comes out in spurts with great force and directly enters the uterus. The later part comes out rather slowly and the last part just trickles out passively. These later parts remain in the back top part of vagina. The mouth of the uterus (cervix) dips in this pool of semen and semen continue to swim up towards the egg if it is released.

So you need not be concerned about the post coital little leakage of the semen; it is physiological. To minimise this leakage, you may follow the instructions:

1. As informed previously, do not pull out the penis actively, let it slip out passively.

2. Do not get out of the bed or sit immediately after the intercourse. Lie flat on the bed for next one to two hours. You may turn on the side also.

I am sure, now your concern about semen leakage has gone. However, if the amount of the leaked out semen is more than about 4 ml, please report to your Gynaecologist.

Please remember, only one sperm is required to fertilize an ovum.

Please feel free to ask me any more advice or queries, XXXX.

Dr. Nishikant Shrotri

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Brief Answer:
Usually small intramural fibroid does not affect fertility.

Detailed Answer:
Dear XXXX,

What is the size of the fibroid?

However, small intramural fibroid - fibroid in the musculature of uterus usually is not known to affect the fertility provided it is not blocking the tubes. Hysterosalpingography can reveal this.

However you have to keep the following facts in mind and follow during pregnancy:

1. These fibroids do increase in their size during pregnancy since complete uterine musculature is undergoing hyperplasia and hypertrophy.

2. Depending upon the site of the fibroid, it may raise some issue if caesarean section is required.

3. These intramural fibroids may interfere in the uterine contractions leading to slow progress of labour and/or bleeding after delivery.

If your Obstetrician is aware of this, he/she will take due care and precaution.

I am there to answer any of your queries, XXXX.

Dr. Nishikant Shrotri

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