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.htm).
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: |
| a) |
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.
|
| b) |
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.htm)
|
| c) |
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 one’s 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.
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
|
