What is Infertility?
Primary Infertility can be defined (WHO Scientific Group 1975) as a couple who has never conceived despite cohabitation and exposure to pregnancy for a period of two years. Secondary infertility exists when a couple already have achieved one pregnancy and thereafter have difficulty conceiving again.
When to begin investigations and treatment depends on the patients needs at the time. This is made more urgent if pregnancy has been intentionally delayed or due to late marriage, the female partner is approaching her late thirties.
Infertility affects 10 to 15% of couples worldwide and significantly we recognise today that in 30% of couples presenting for consultation a significant male factor is the contributing factor.
Causative factors amongst women are commonly pelvic infections, ovulation disorders, endometriosis.
Investigation of infertility involves the couple and is directed towards uterine, tubal and pelvic abnormalities, hormonal status, and endometriosis in the female. In the male, semen assessment and related congenital, infective, and hormonal abnormalities have to be assessed. Sexual dysfunction in the couple should not be ignored as a contributory cause of infertility.
Only when investigations have been completed can appropriate treatment be directed towards assisting them to achieve a pregnancy.
What treatment options are currently available?
The level of treatment intensity and complexity depends on the duration of infertility, the age of the couple , and the severity of the infertility factor or factors that are present.
Currently available treatments include:
1. Ovulation induction for timed intercourse or insemination.
2. Tubal, pelvic surgery for obstructive tubal lesions or pelvic adhesions. In males surgery may be an option in obstructive lesions occluding the vas deferens or if large varicocoeles are a problem.
3. More intensive ovulation protocols for IVF-ET (Invitro fertilisation and embryo transfer) for patients who have failed other treament modalities or for women with tubal obstruction.
4. ICSI (intracytoplasmic sperm injection) for severe semen/sperm disorders or for failed IVF.
5. Frozen gamete or embryo procedures.
6. Gamete donation
7. PGD (pre-implantation genetic diagnosis) with IVF and ICSI.
For more information on infertility, investigation and treatment you can link to www.fertilityjourney.com.my
Questions to Ask
In order to help you understand your treatment better, you can make a list of any questions or concerns you have and bring it along with you when you go for your consultation. For a start, you can use the checklist below for asking questions.
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