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Investigations
All couples should have the following tests:
· Seminal fluid analysis
· Tests for ovulation
· Other hormone tests
· Tests for fallopian tube patency.
Seminal fluid can be analysed in many different
ways. Some laboratories can do extremely complicated
tests which may be useful. The basic question
though is: ‘are there sufficient numbers
of normal, good quality, motile sperm present?’
If not, can anything be done about it?
Ovulation kits have becoming widely available.
Ask you chemist for assistance. They are all based
on detecting the surge in LH and FSH which are
hormones that control ovulation. These hormones
can be measured on blood tests as can Oestrogen
and Progesterone. Taking samples for these in
different part of the cycle may help. Ultrasound
monitoring can also determine if ovulation has
taken place.
Other hormone tests are not always necessary if
ovulation is taking place. But in some cases tests
for Thyroid function, Testosterone and Prolactin
may be helpful.
There are different ways to check tubal patency.
At ultrasound scan fluid may be injected into
the womb. This will show if the cavity is normal
and will also show if the tubes are patent. This
test is not widely available.
Fluid may be injected into the womb under X-ray
control to give the same information (Hysterosalpingogram)
The definitive test is to look inside the womb
under general anaesthetic (hysteroscopy) and to
visualize the fallopian tubes at laparoscopy.
Blue dye is then passed through the tubes (hydrotubation).
This test shows whether or not the tubes are patent
and also gives information as to why they might
be blocked. In addition it allows us to look for
endometriosis as a cause of infertility. Sometimes
surgery can then be performed to improve the state
of the tubes or to excise endometriosis.
In many couples no obvious cause can be found
this does not mean that we should delay treatment.
Once a diagnosis has been made, plan what to do
next. Do you need to attend a specialist fertility
clinic or can you current specialist deal with
your problem? There are a number of treatment
options depending on diagnosis.
· Manage conservatively for 6 months
· Try to improve sperm quality.
o
General health issues.
o
Refer to andrologist/urologist
· Induce ovulation.
o
Oral medication
with chlomid (metformin in PCO)
o
Gonadatrophin injections.
· Cycle monitoring with intrauterine insemination.
· GIFT
· IVF
· ISCI
In each of the more technical treatment arms there
are possible refinements that may improve outcome
such as the type of sperm preparation, ‘hatching’
and uterine preparation. These are all highly
technical and vary from one fertility clinic to
another. Check the published success rates of
the clinic you attend and analyse the results
carefully. The most important thing is to formulate
a plan of action. This reduces stress and stops
time wasting!
Whatever path is chosen it is important to remember
that treatment is extremely time consuming. It
takes over peoples lives and can be highly destructive.
For this reason all respectable clinics offer
counseling throughout treatment. Make sure your
emotional needs are being met.
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