Dr Noah O. Olaomo
In the previous article, we have identified the various causes of infertility. In this piece, we would be considering the various ways of investigating and managing it-
These are the tests (investigations) used in evaluating a couple for infertility.
a. Seminal Fluid Analysis/Seminalysis (SFA): Commonly referred to as sperm count test. This tests the quantity and quantity of sperm. This is the main test for testing male d/fertility. The couple will abstain from sex for 3-5days before the test is done. Semen sample can be collected by withdrawal method or masturbation. Some couples justifiably have reservation to semen collection by masturbation on religious ground. A normal sperm count is between 20-200millions/ml of semen.
b. Hysterosalphingogram (HSG): This tests the patency of the tubes and the uterine cavity. Also useful in diagnosing Asherman’s syndrome. HSG is also the test that is often used to diagnose congenital anomalies of the uterus.
The test makes use of Xray and is invasive. So, it must be very certain that a woman is not pregnant before the test is done. It is usually done in the first 10 days of the menstrual cycle. In some women with tubal blockage arising from mucus plugs,the tubes might become open after HSG.
c. Ultrasound scan (transabdominal/transvaginal): Helps to detect fibroid and or ovarian cysts. It may also suspect the absence of the uterus. It is also useful in monitoring ovulation. It is very safe and can also be done through the tummy (transabdominal) or vagina (transvaginal).
d. Hormonal Profile: This assesses the levels of the different hormones involved in regulating reproduction. It is usually requested for the woman but the man may also be requested to do it occasionally. Common hormones usually requested for are prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), oestrogen, progesterone and testosterone.
Here are some of the treatments of infertility, however, this is determined by the result of the investigations
a. Anovulation: The treatment will be determined by the cause of anovulation. Galactorrhea is treated by suppressing prolactin with appropriate drugs. Ovulation can also be induced with appropriate drugs. The appropriate drugs will be determined by your doctor after due interaction and investigations.
i. Fibroid surgery (Myomectomy): In women with troubling fibroids, those with fibroids and having recurrent miscarriages and those who have fibroids and can’t find a cause of the infertility after running all tests, fibroid surgery (myomectomy) is recommended.
ii. Surgery to open up blocked spermatic duct: For men that tests have confirmed blockage of their spermatic ducts, urologists can operate on the ducts to remove the blockage.
iii. Surgery to remove varicocele: This surgery will be done by a urologist or a general surgeon.
c. Treatment of sperm count abnormality: There are some drugs that have been proven to help in correcting some sperm count abnormalities. Some men may benefit from these drugs.
d. Assisted Reproduction Techniques (ART).
This includes In Vitro Fertilization and Embryo Transfer (IVF-ET). There is a set of infertile couples that the only way out of the infertility is to undergo ART. There are many techniques involved in this. Some women who are advanced in age may need donor egg and some men may need donor sperm. However, there are technologies that can help even men with very low sperm count to use their own sperms for the ART.
Women who have lost their wombs or whose wombs cannot carry babies and with or without functioning ovaries can use surrogate mothers to have their babies.
*A surrogate mother* is one who carries a pregnancy for another woman under a contract. After delivery, she hands over the baby(ies) to the contracting couples.
As it is usually being said, prevention is better than cure; a lot of causes of infertility can be prevented. The following steps will go a long way in enhancing your reproductive health and preventing infertility.
a. Lifestyle modification: Cessation of drinking and smoking should be encouraged. Avoid immorality and multiple sexual partners.
b. Proper antibiotic treatment of infections. Stop patronizing quacks and chemists. A doctor is the appropriate qualified health professional qualified to prescribe drugs. Sexually Transmitted Diseases and Pelvic Inflammatory Disease should be properly treated. Non-treatment and improper treatment of these disorders lead to complications.
c. Patronize medical experts for your medical needs including surgeries.
d. Marry early when possible and feasible.
e. Pay adequate attention to your health: Detect and treat health challenges early.
Dr Olaomo Noah Oluwafemi is a Consultant Obstetrician and Gynecologist with a love for writing. His desire is to enhance people’s lifestyle and effect positive change in their health through his writings