Sat | Aug 19, 2017

Infertility - there is still hope (Pt 2)

Published:Wednesday | January 27, 2016 | 1:00 AM

Continuing from the article last week - 'There is still hope for infertility' - today, we look at how to know if you have a problem with fertility.

 

HOW DO YOU KNOW?

 

So how will you know if you have a fertility problem? Infertility is a problem that involves both partners. Diagnostic testing is unnecessary if the couple has not tried at pregnancy for at least one year, unless:

1) The woman is age 35 years or older, or if

2) There is a history of a male-factor infertility, endometriosis, pelvic inflammatory disease, or polycystic ovarian syndrome, all known to cause infertility.

Evaluation starts with your doctor's visit, where a detailed medical history will be taken for both partners. Do not be daunted by all the questions. A lot can be discovered from these seemingly pointless questions, and it can guide us along the next step, as to which investigation to go to first.

For women, complete infertility evaluation is performed according to their menstrual cycle and may take up to two menstrual cycles before the cause is determined; whereas, for men, the main investigative tool is a semen analysis (sperm test), which is a lot easier than the testing done for females. For this reason, we ideally like to start with investigating the male first, as if there is a problem, and there often is, it can be discovered and managed a lot earlier.

 

So there's a problem; what next?

 

The choice of treatment is dependent on the cause for the infertility. Treatment can vary from lifestyle modification, to medical management, to surgery.

If there is any underlying medical condition that is affecting either partner's fertility, it has to be managed/treated first; and these also may require medical treatment, surgical intervention, or both. Once done, attempts at pregnancy can be resumed.

Lifestyle modification can involve dietary and weight adjustments, cessation of smoking, or even discontinuing the use of some herbal remedies.

Medical management will involve taking medications which are aimed at ensuring an egg is always present for fertilisation. These should be prescribed by a gynaecologist, who will explain how they should be taken, in order to avoid multiple pregnancies (twins and triplets).

Assisted reproductive technologies (ART's) are usually what most couples fear. These include Intrauterine insemination (IUI), Intracytoplasmic sperm injection (ICSI), and In Vitro Fertilisation (IVF), to name a few.

If pregnancy has not been established within a reasonable time using ART's, further evaluation may be considered, and/or an alternative treatment plan, such as the use of donor eggs or sperm.

I have chosen to mention this last, separate from everything, because I didn't want it to get lost in the midst of everything. The problem of infertility is quite stressful, heartrending, and nerve-racking. Added to the stigma society places on it, many women suffer, often in silence, at the thought of not being able to have a child, as being seen as less of a woman... an 'old mule'.

The constant questions that are posed by others are often of no help...., "how long you married and don't have no baby yet?" It is easier said than done, but RELAX!!! Stress is something no amount of medication, or fertility treatment can help, and often times, you haven't even been really trying effectively, and really just stressing over nothing.

I will leave all those women in this group with a story of a patient I had a while back. She was like most women, convinced something was wrong with her, and that's why she wasn't getting pregnant. Well, she eventually did and unfortunately miscarried.

Time passed again and after trying and no pregnancy was achieved, she was started on fertility medication. After six months on the medication and no pregnancy was achieved, she gave up. She left the clinic with tears in her eyes saying, "Maybe pregnancy and motherhood was just not meant for me". I felt her pain.

Four months later, she returned. I was very apprehensive to bring up the topic again, so started with small talk... . "Hi. How have u been. You look happy", to which she responded with the biggest smile, "I am very happy doc! I am pregnant and at the end of my first trimester and would like you to write my referral to the antenatal clinic." I remember screaming and giving her a big hug. Notice, the moment she gave up and decided to move on and focus on something else, she conceived.

So relax, give it time, Rome wasn't built in a day.

- Dr Rhonda Reeves is the Obstetrician/Gynaecologist at Southdale Medical & Gynae Centre, Shop 6, Southdale Plaza. Email: yourhealth@gleanerjm.com.