What tests are used to diagnose infertility?
Typically, couples are seen together when diagnosing infertility
. The doctor will take a note of the couples' full medical histories and this will be followed by an examination. They will also be asked about the use of prescribed or illegal drugs, alcohol and tobacco, and whether there is a family history of infertility or genetic disorders.
Women can expect questions about their menstrual history, including the age of onset and any difficulties with menstruation. They also will be asked whether they have noticed milk leaking from their breasts.
Women may have to undergo a genital examination, as well as a cervical smear. Blood tests are taken to measure prolactin levels and thyroid function and sometimes to test for certain hormone levels, such as progesterone and oestradiol. A post-coital test, which is similar to a cervical smear, may be required to see if the sperm can penetrate the cervical mucus.
Sometimes an ultrasound scan of the pelvis is taken to check for fibroids in the uterine cavity. A laparoscopy also may be performed, in which a lighted camera is passed through a hole in the abdomen to look at the pelvic structures. Occasionally, a hysteroscopy is required, in which a thin, lighted tube is passed into the uterus to directly examine it.
Men will be required to provide a semen analysis. They must abstain from sexual intercourse for three days before providing the sample. If the initial sample is abnormal, another will be required. The volume of semen, the sperm count, how the sperm move (motility), as well as the presence of immature sperm are checked. If the second sample is abnormal, your doctor may advise the man to have a genetic blood test is performed to make sure that there are no chromosomal abnormalities or defective genes that could be passed on to potential offspring. Blood tests also may be taken to determine levels of testosterone.
What treatments are available?
Increasing your chances naturally
If you have been having trouble conceiving do not give up hope, as spontaneous pregnancy may occur on its own. In many cases, couples are simply not having enough sex at the right time to conceive. To increase the chance of getting pregnant, intercourse should take place around the time of ovulation.
For women with a regular 28-day cycle, ovulation occurs around day 13-15. Women with irregular periods will find it more difficult to pinpoint their most fertile time. Some over-the-counter tests can help you determine the best time to conceive, although no products are guaranteed to be 100% accurate. Indications for ovulation include a rise in body temperature and a thinning of the cervical mucus. A female egg lives only twelve hours, however sperm can survive in the female genitals for close to 72 hours.
Sperm that are waiting in the female genitals can immediately fertilise the eggs once ovulation begins so you will increase your chances by having regular sex for a few days before ovulation. Lubricants that contain spermicides, such as K-Y Jelly, should be avoided.
In situations where a woman develops antibodies to her partner’s sperm, the use of a condom for thirty days may allow time for the antibodies to decrease and intercourse should then take place during ovulation.
If timing intercourse around ovulation does not work, a general physician may then prescribe various courses of treatment, such as stimulating ovulation with a drug called Clomiphene. Side effects include hot flushes, vaginal dryness and ovarian cyst formation. The number of eggs that you release cannot be controlled precisely so there is a chance that several eggs could be released at once thereby increasing your risk of multiple pregnancy
Other drug treatments include the use of either Bromocriptine or Cabergoline, which act to reduce the levels of prolactin. Check with your general physician about possible side effects of any drug prescribed.
What about assisted reproduction techniques?
There are several ways of bringing sperm and egg together to achieve fertilisation. The most commonly performed procedures are IVF (In vitro fertilisation) and ICSI (Intra cytoplasmic sperm injection). IVF is only considered in special cases and is not suitable for everyone. In vitro candidates are women who have experienced pelvic disease, endometriosis or unexplained infertility.
The process involves an intensive programme of hormonal treatments and harvesting of the eggs. The eggs are then mixed with sperm in a laboratory, (typically 1000,000 sperm to one egg to allow one or more embryos to form) after which the embryo is transferred to the uterus. The success rate varies, although the average is about 20-30%.
ICSI is often done if the sperm count is low or if sperm are unable to fertilise an egg.
One sperm is injected directly into the centre (nucleus) of one egg using a very fine needle. In some circumstances if sperm cannot be obtained from semen they can be taken straight out of the testicles under an anaesthetic. This procedure is known as TESA (testicular sperm aspiration). ICSI has an average success rate of 35-40%.
GIFT (Gamete Intra-fallopian transfer) is less commonly used but is sometimes performed if there are cervical barriers to conception. IUI (Inta uterine insemination) where the sperm are flushed into the uterus via the cervix by means of a fine catheter is also occasionally done.
Can complementary therapies help?
Herbs that may enhance sexual functioning in men include damiana, ginseng, sarsaparilla and saw palmetto. Damiana, dong quai, ginseng, gotu kola and wild yam root may enhance sexual function in women. Most of these herbs are available in tablet form from health food shops but you should consult a qualified herbalist and check with your GP before taking them.
As anxiety may contribute to infertility, incorporate stress management techniques into your daily routine.
The importance of preconceptual care
If you are trying to get pregnant, regardless of the method, you should drink only in moderation, do not smoke and avoid any drugs other than those prescribed by your physician. Exercise only lightly and avoid hot tubs and saunas, as they may lead to a lowered sperm count or changes in ovulation. Be sure to get plenty of fresh fruit and vegetables into your daily diet, as they contain folic acid, which helps prevent neural tube defects in the baby.
Maintain an appropriate body weight, as being over- or underweight can affect fertility. Also, make sure you receive a rubella vaccination if you have not already had one. It is important to note that pregnancy should be avoided for three months after a rubella immunisation.