Are  Investigations  Really  Necessary in Female  Fertility Treatment ?

SATURDAY FAMILY HEALTH 

By Bobo Bode-Kayode, lifeissuesfromwithin

The human body is a very complex system and there is certainly no single and concrete way of finding out what could actually be wrong when there is a general feeling of ill health.

It is also more worrying, when a particular complaint, could be an indirect pointer to another ailment in an adjoining organ or part of the body.

At a point when a woman desires to get pregnant, all her senses are geared towards achieving this desire. I see a male as a gamete deliverer and a female as a receiver of such vital gamete, providing a conducive incubator, environment for a baby to be formed, nurtured and born. This is an enormous task.

So with these understanding, what should be your focus when you and your partner, go to see your doctor, when you have both tried several times, to get pregnant, and you are unable to do so?

How usual is it to have problems conceiving?

Eighty per cent of couples who have regular sexual intercourse (that is, every two to three days) and who do not use contraception will get pregnant within a year. The majority of the remaining 20 per cent achieve a pregnancy within two years of trying.  An estimated one in seven couples has difficulty conceiving. There are several possible reasons why it may not be happening naturally. In men, a fertility problem is usually because of low numbers or poor quality of sperm.

Women become less fertile as they get older. For women aged 35, about 95 per cent who have regular unprotected sexual intercourse will get pregnant after three years of trying. For women aged 38 only 75 per cent will do so. The effect of age upon men’s fertility is less clear. Your lifestyle can affect your chances of conceiving, particularly if you are a heavy smoker and are significantly over- or underweight.

Problems affecting women include damage to the fallopian tubes and endometriosis and erratic or absent ovulation.

Sometimes infertility problems can be due to a combination of factors.  In a third of cases, a clear cause is never established.

The first step then is for you to book an appointment to see a doctor you can trust and confide in. A fertility doctor is your target. This is important because if you do not trust or confide in your doctor you have actually created a gap in your treatment process.

At a time when you walk into the clinic, empty yourself of all predetermined thoughts before treatment. Approach the doctor you have chosen with confidence and a mind of no holding back of vital information. Why is this necessary? This is so vital because if you hold back vital information about yourself you could actually be leading your doctor’s thought process down the wrong path.

The clinic would collect vital information from you about yourself and your partner.

The female most of the time is the primary focus for investigation. Courtesy Google

TYPICAL TREND OF INTERACTION WOULD INCLUDE :

·   Are you still ovulating?

This is important to ascertain that you are still producing and releasing eggs at all.

It is therefore important that your ovulation should be assessed by measuring your hormones that are responsible forovulation.

A blood test during your period to check for hormone imbalances – measurement of FSH (follicle stimulating hormone, LH (luteinising hormone) and oestradiol. This test can also identify possible early menopause as a cause of sub-fertility.

·  Are you still having your monthly periods?

This is important because you need to have a monthly flow as an indication that your hormones and uterus are still in sync in the reproductive process.

The duration and frequency are important.

This would then necessitate measuring your hormonal levels. Your fertility Hormonal profile would be measured.  These include FSH, Progesterone, Luteinising Hormone, Prolactin, E1, E2, Oestradiol.

· Have you had any STDs?

This is important. Current or recent Chlamydial infections can be the reason that you are unable to get pregnant. Chlamydial infections could be latent with or without symptoms. Therefore, you would be asked to do a Chlamydia test blood.

· Ultrasound scans?

This would be done to see the state of your tubes and womb and the surroundings, cervix and vagina.

A 3D or 4D colour scan would give a very good clear picture of your anatomy.

This can also be carried further by doing a more directed minor diagnostic procedure.

· Hysteroscopy:

This is a very simple painless procedure whereby a fine microscope is passed into your body to have an internal assessment of your full reproductive organs. The procedure would give an in-depth visual assessment. It is a modern and very effective method of fertility assessment.

· Dye Test:

This can be done along with the hysteroscopy to assess the state of your fallopian tubes. A harmless coloured dye is flushed through your fallopian tubes to check for a spill. A spill would indicate that your tubes are open and healthy. While a reflux would indicate that your tube is blocked.  

·  Anti Muellerian Hormone  (AMH):

The number of eggs you have in your ovaries would be measured. This is important because every woman from birth has a certain number of eggs that can be produced by your ovaries.

When this is measured in your blood it gives the pointer as to the possibility of you being able to produce eggs at all. This is so important especially with older women and repeated failed egg collection because it helps in a quick decision to be taken as to whether you can use your own eggs or use donor eggs. This helps to save time wasting.

I have seen patients arguing as to whether it is important or not because of the high cost of this test. With most of these basic tests done you must then bear these vital information behind your mind:

When am I most fertile?

For a woman to get pregnant;

·   Intercourse must take place around the time when an egg is released from the ovary

·   The systems that produce eggs and sperm have to be working at optimum levels

·The fallopian tubes must be open and healthy.

·   Eggs live (and can be fertilised) for 12–24 hours after being released.

·  Sperm can stay alive and active in your body for 12–48 hours after ejaculation so you don’t have to have intercourse at the exact moment of ovulation to get pregnant.

·      It just takes one sperm to fertilise the egg for you to become pregnant. Although millions of sperm are released upon ejaculation, few survive the journey through the cervix, uterus and fallopian tubes.

·      If fertilisation does not take place or if the fertilised egg does not attach itself to the endometrium lining of the uterus it breaks down, the endometrium is shed and you have a period.

The bottom line is that with a clearer explanation and understanding of what these basic tests can do assisting you and your fertility specialist in taking decisions very quickly with a view to getting the problem solved as quickly as possible.