You have been married for some time now and have had enough of the honeymoon years. Finally you and your partner are ready to settle down and start a family. Time to have some pitter-patter to brighten up your lives and home!
Yet, after many months or years of trying, nothing seems to happen. This is when you start to think- Is there something wrong? Should I get myself tested? Where can I go for advice?
According to Dr Wong Pak Seng, an Obstetrician and Gynaecologist specialising in fertility and Clinical Director of Sunfert International Fertility Centre located at the Sunway Medical Centre, you should get yourself tested if you have been trying to conceive unsuccessfully for a year.
Around the world, about 1 in 10 couples have some form of fertility problems. In Malaysia, approximately 350,000 couples have problems conceiving naturally, and the number is increasing as people get married later than before.
What happens during a fertility assessment? Dr Wong outlines the steps below:
STEP 1: MEDICAL HISTORY
The first step is to take down the medical history of the couple.
For women, the fertility specialist will note the menstrual cycle, whether there is pelvic pain or difficulties with sexual intercourse, past pelvic surgery and any symptoms that suggest other medical conditions. For example, if the woman has irregular menstrual cycles, the problem is likely to be related to ovulation.
For the male partner, the specialist needs to know whether he is a heavy smoker or drinker, and if he have had previous surgeries done to the private part such as hernia or undescended testis.
If the couple has previously sought fertility treatment elsewhere, the records of previous treatments and investigations will be reviewed so that no unnecessary procedures are repeated.
STEP 2: PHYSICAL EXAMINATION
A full physical examination and specifically an internal pelvic examination are performed for the female partner to identify physical problems causing infertility, such as a large fibroid and a fixed position womb which suggests scarring of the tubes. Sometimes tender nodules can be felt, which could indicate a condition called endometriosis.
Being over or underweight can also cause problems. Some overweight women have male features such as excessive facial hair and acne and are likely to have a condition called Polycystic Ovarian Syndrome (PCOS).
It is rarely necessary to examine the man, unless the semen analysis is extremely abnormal. Examination concentrates on detecting small volume testicles or a condition called varicocele, where dilated testicular blood vessels lead to overheating of the testicles.
STEP 3: ULTRASOUND AND X-RAY TESTS
A transvaginal ultrasound is conducted to identify the cause of infertility in the female, such as the shape and size of the womb as well as the regularity of the cavity of the womb. is important. Sometimes the doctor may put some fluid into the uterine cavity to have a better view. The appearance of the ovaries as well the number of potential eggs that are available will give a better idea of the woman’s ovulation capability.
Occasionally, the woman undergoes an x-ray examination to assess the condition of the Fallopian tubes.
STEP 4: BLOOD TESTS
Blood tests are done only if the woman has irregular menstrual cycle, is aged above 38 and is suspected to have low ovarian reserves. Blood tests are performed to determine the hormonal profile which includes Follicular Stimulation Hormone (FSH), Luteinising Hormone (LH) and Oestradiol levels.
A clomiphene citrate challenge test may be advised to further assess the ovarian reserve. This involves taking a baseline blood test, followed by a course of fertility tablets called clomiphene to stimulate the ovaries. Another blood test is taken to compare the results.
For couples with recurrent pregnancy losses or IVF failures, it may be necessary to conduct more tests, which includes a screen of the couples’ chromosome make up (karyotyping).
STEP 5: TREATMENT
Treatment depends on the causes of infertility. Causes of infertility can be broadly divided to male factor only (35%), female factor only (35%) or combined (20%). In 10% of couples, no causes can be identified (unexplained).
- If there is a lack of egg production, doctors would use ovulation induction medications
- If sperm quality is poor or have difficulties with intercourse, the couple should try artificial insemination (IUI)
- If there are presence of cysts or endometriosis or unfavourably situated fibroids, the woman may need surgery
- If the tubes are blocked beyond repair or the sperm is profoundly poor; the couple may need Assisted Reproductive Techniques (ART) or test tube baby treatment such as Invitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI).
You doctor would plan your treatment according to your needs and the cause(s) of infertility. Every treatment plan is individualised and is aimed at assisting you to achieve a pregnancy with the quickest route and at the minimum cost.
CAUSES OF INFERTILITY
- 35% – Female
- 35% – Male
- 20% – Combined
- 10% – Unexplained
Sunfert is a one-stop patient-centred fertility centre providing a complete range of fertility services, investigations and treatments including IUI, IVF, ICSI, sperm and egg donation and freezing programmes and laparascopic keyhole surgery. For more information or to contact a specialist, visit www.sunfert.com or call the Sunfert Careline: 018-230 1818 (24 hours).