Infertility - a simplified approach
Infertility has become a major problem today. Most surveys put the percentage of couples remaining childless involuntarily at above 20% in developing countries. Much of the blame has been put on the rise in average marriage age of women (and men).
Younger women have a better chance of trying to get pregnant. In the United States, a study in 1998 showed that In-Vitro Fertilization (IVF) pregnancy rates fell from 27% in those under 35 to 14 % in those between age 35 and 40 (http://www.gynae.com.sg/eng/gynaecology_infertility.html). The success rate in those above 40 was down to a low 7%. This is an accurate reflection of couples attempting to have babies - it gets harder after age 35 and extremely difficult after 40.
Causes of Infertility
There are many causes of infertility. About a third of the cases can be due to male factors, another third to female factors, and a final third with contributing factors from both.
Poor sperm count is the most common male problem accounting for up to 90% of male problems and is a contributing factor in about a half where both partners have problems. This problem is with easily detected by a simple microscopic examination of semen. However, this is not often asked for as there is a mistaken notion linking sperm quality to sexual prowess.
Common problems in women include:
- Ovulatory disorders (when eggs are not properly produced every month).
Women with irregular and infrequent periods often have this. Treatment with medication such as Clomid is often sufficient to correct this. >
- Blockage of fallopian tubes
This can occur if there was previous pelvic infection, surgery or appendicitis. Special X-rays called hysterosalpingograms (HSG) can usually confirm if the fallopian tubes are blocked. Laparoscopy can also detect this problem
(http://www.gynae.com.sg/eng/gynaecology_laparoscopy.html)
- Endometriosis
This is a condition in which tissue from the lining in the uterus (endometrium) grows outside the uterus, being on the ovaries or outer surface (serosa) of the uterus. Severe forms of the condition are detectable on ultrasound but milder forms escape detection by all except laparoscopy.
Microscopic view of sperm
While it is to useful to know what the possible causes of
infertility may be, finding out ones own problem is not so easy. As a
start it would be good to plan a visit to an infertility specialist. Preliminaries
will include discussing with your family physician about which infertility
specialist is suitable for you. Chatting with friends and surfing the
net are alternatives but have their pitfalls.
Collecting your old medical records to bring along will be useful - old
blood test may not be current but would give an indication of past problems.
A record of recent periods will help.
http://www.inciid.org/article.php?cat=&id=79
During the visit, be prepared to answer questions dealing with intimate
details. A physical usually includes a pelvic examination. It is necessary
for a nurse to be around for this examination. An ultrasound examination
may round off the consultation.
Usually a diagnosis is arrived at and recommendations are given. Do not
be afraid to ask questions, especially if you do not fully understand.
Recommendations can include a
hysteroscopy
or a
laparoscopy.
Contributed by:
Dr. Yap Lip Kee, Consultant Gynaecologist
Dr. LK Yap Surgery for Women
www.gynae.com.sg
A Member of eMenders www.emenders.com
A member of Singapore International Assist
www.siassist.org
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