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FIRST-STAGE TREATMENT
The initial treatment of a couple's failure in conceiving really
starts, when by mutual agreement they decide to seek medical help.
This will involve an investigation into the couple's past sexual
history, the woman's menstrual cycle and any other relevant matters.
It will then be explained at what stage the woman is at her most
fertile and how to obtain an ovulation/temperature chart. In fact
through this simple considerate advice and guidance many couples do
conceive shortly afterwards, be this due to combating any worries
that may have been present or just receiving the needed education to
enhance their chances.
BASIC METHODS FOR UNCOVERING MALE INFERTILITY
Semen Analysis Three semen analyses are usually required to be able to diagnose a
problem, this being due to the results varying according to the
particular circumstances of the sperm cell collection.
The procedure would involve, abstinence from sexual intercourse for
three to four days, then upon masturbation, a sample will be
collected in a sterile jar, and sperm analysed for sperm morphology
(appearance), motility (mobility), volume and chemical constituents.
If the results indicate that there is indeed a problem with either
quality or quantity, further tests will need to be carried out to
establish the underlying problem. These investigations may include
X-rays where upon it can be established whether there are any
blockages or abnormalities of the tubes concerned; blood tests in
order to check the hormonal levels involved in sperm cell production
and a needle-biopsy, whereby the doctor will be able to assess at
what stage the sperm cells are maturing and whether immature sperm
cells are being produced. An infection of the prostate gland may
also come under question if the sperm quality appears to be poor.
Mucus Penetration Testing This test allows for the evaluation of the sperm's ability to 'move'
through mucus-like substances, which resemble that of the females'
reproductive tract.
Sperm Penetration Assay
Also known as the 'hamster test', this method allows for the testing
of the sperm's ability to effectively fertilise a hamster egg - with
the assumption being that if it proves to be a success, then there
should be no problem in it being able to fertilise a human egg. A
newer version of this test, known as the Hemizona Assay, involves
the use of human eggs, however this method is still in the
experimental stage as spare human eggs are not freely available.
Post-Coital Testing
This test allows for the examination of the sperms reaction to
cervical mucus. It may show for instance that the woman is
'sensitive' to her partner's sperm, and that it would require
'washing' so as to eliminate any antibodies that may be preventing
conception.
The Acrosome Test
This procedure tests the sperm's ability to release the enzymes that
allow for it to rupture the outer covering of the woman's egg.
TREATING INFECTIONS
Effective eradication of any infections that may be present in
either partners' genital tract is vital in the initial stages of
treatment. Thrush (candida) is the most common of infections, and
although it may not suppress fertility completely, one would stand a
higher change of conceiving if this were to be completely cleared.
The unfortunate being that this infection can be transmitted via
sexual intercourse so it will be necessary for both partners to be
treated simultaneously or if detected early enough then the use of
condoms and treatment for the sufferer will be sufficient in
preventing the spread of infection.
Tubal Blockages Unfortunately many tubal infections may occur without the woman
actually becoming aware of a problem, and by the time she does seek
treatment for infertility, permanent damage could already have
occurred.
The hysterosalpingogram is one method a doctor may use to assess
whether there is a tubal problem, and what type of, (if any) surgery
is required. This procedure would normally be carried out in the
X-ray department, whereby the doctor will, by using a speculum
(special device designed to fit the vagina) be able to view the
cervix. He will then attach a tube, through which a special dye will
be injected to assess whether there is a blockage. The dye will pass
through the uterus and fallopian tubes, however if there is a
blockage it will not pass into the abdomen, and this will be clear
from the X-ray picture.
This procedure has been reported to be fairly painful, and may have
the disadvantage of causing allergic responses, which should be
reported to your doctor.
The second route would be that of a Laparoscopy, which is a surgical
procedure that allows for visual inspection of the tubes, ovaries
and uterus. This method would also help in the diagnosis of
endometriosis, tubal disease and fibroids. This is probably a more
complex procedure, in that it would probably require a general
anaesthetic. The surgeon would make two small incisions, one through
the umbilicus (belly-button) into which a lighted-eyepiece would be
inserted, which would allow the doctor to view the inner abdomen and
the other would be an incision just above the pubic hairline at the
bas of the abdomen, into which forceps would be inserted to enable
the doctor to move the ovaries, tubes or uterus into view. Following
this, a dye would be passed through the cervix into the uterus and
tubes, where any blockages and general health of the tubes could now
be noted.
CERVICAL MUCUS PROBLEMS
There are times when on examination a woman's cervix opening can
appear to be almost raw, this is commonly known as cervical erosion,
and although it is not an infection in itself it will need
appropriate treatment to 'clear' the disorder.
Cervical erosion could mean that the woman's hormonal profile is
disordered, causing the mucus secreting cells to become congested,
broken down or overactive thus preventing conception. This problem
can, after being diagnosed be effectively treated by the woman
receiving hormone treatment such as a short course of an oral
contraceptive in which case the 'eroded' area would heal and
hopefully fertility restored.
TREATING ENDOMETRIOSIS
If endometriosis is responsible for infertility, drug therapy and/or
surgery will be necessary. In mild cases the use of
progesterone-type drugs may be sufficient to cure the problem, but
if the endometriosis has caused large cysts that are affecting the
ovaries, then surgery as well as drug treatment may be required.
Drug treatment would usually involve the use of Danazol, which will
reduce the growth of endometrial tissue, however it does seem to
have negative side effects such as weight gain and breast size
reduction. If the cysts are relatively small it may be possible for
them to be cauterised and destroyed, but if they are large,
abdominal surgery will be necessary, where the damaged tissues can
hopefully be reconstructed and together with a course of drug
treatment, fertility fully restored.
Treatment of this disorder is quite a complicated affair, therefore
it will be necessary for the patient to receive adequate explanation
and counselling so that the best results can be obtained in the
shortest possible time and that any further signs of endometriosis
may be recognised immediately. |
