Infertility

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Infertility  is  a  condition  of  the  reproductive  system  defined  by  the  failure  to  achieve  a  clinical  pregnancy after 12 months or more of regular unprotected sexual intercourse. A detailed history taking, and physical examination are invaluable for the diagnosis for causes of  infertility 

Investigation

Not every fertility test will be done for every case. 

WOMEN: For women, fertility testing may include basic gynaecologic examination 

  • VDRL tests 
  • Urine routine and microscopic 
  • Cervical mucus examination 
  • Abdominal pelvic/Transvaginal USS 
  • HSG (hysterosalpingogram)for tubal patency  
  • Hysteroscopy- 
  • Diagnostic  laparoscopy-  This  test  is  only  done  when  symptoms  point  to  possible endometriosis,  as  part  of  treatment  for  blocked  fallopian  tubes,  or  in  some  cases  of  unexplained infertility. 
  • Hormonal  profile-  FSH,  LH,  TSH,  AMH,  T3  &  T4,  Testosterone,  prolactin,  estradiol  and progesterone.

MEN: Perform the following 

  • Semen analysis 
  • VDRL tests 
  • Hormonal profile-FSH, Testosterone, but sometimes also LH, estradiol, or prolactin 

Treatment - Will depend on the underlying cause 

Non-pharmacological Treatment 

  • Weight reduction in obese clients. 
  • Educate  the  couple  on  the  importance  of  having  sexual  intercourse  during  the  fertile window 
  • Try to avoid smoking/excessive drinking 

Pharmacological Treatment Ovulation stimulation; 

C:   clomiphene   citrate   (PO)   50mg   24hourly   for   5days   from   the   2nd–5th   day   of  menstruation. (maximum 6 cycles) 

Polycystic Ovarian Syndrome (PCOS) 

A: metformin (PO) 500mg 8hourly is used for PCOS treatment, alone or along with fertility drugs 

Hyperprolactinemia 

C: bromocriptine (PO) 2.5–5mg 24hourly until the prolactin level is within the normal range 

OR 

S: cabergoline (PO) 0.25–0.5mg once or twice weekly initially then the dose is gradually increased monthly until prolactin levels normalize. Doses of less than 3mg per week are  usually enough to achieve this goal 

Surgeries: 

  • Tubal surgery for Tubal blockage 
  • Myomectomy for uterine fibroids 
  • Ovarian drilling is a possible surgical treatment for PCOS–related infertility 

Referral: Refer all patients with infertility to a gynecologist.