Dr. Abayomi Ajayi
I have heard some couples seeking fertility treatment use
the expression “Hit-or-Miss” when talking about Assisted Conception Methods. No
doubt one question that is agitating the minds of almost every couple seeking
treatment for one problem of infertility or the other is the probability of
achieving success on the long run.
Today I’ll discuss how couples can avoid getting entangled
with the “hit-or-miss’ phenomenon of fertility treatment.
I’ll begin by
pointing out that irrespective of the odds, taking up fertility treatment
should not be seen as a gamble even in the face of the realization that the
infertility experience could be more of an emotional than physical challenge. While
it could be admissible that Assisted Reproductive Assistance may
not work for everybody all the time, the approach I would recommend any couple
seeking a successful outcome to adopt is to have a positive approach. It does
not hurt to expect that any fertility treatment option you choose would always
work for you. But a successful outcome to any treatment plan does not just
happen by accident. It is a deliberate event that begins with a positive
approach and the determination to succeed.
We have long established that infertility affects the
couple, not just the woman or the man as an individual, thus it is important
that both parties (the man and woman) learn as much about fertility problems
and treatment as they can. The idea is that this approach will put them in
position to ask the right questions and spot potential problems.
With a reasonable understanding of the conditions necessary
for conception, you will be able to help your physician provide the best opportunity
to reach your fertility potential. Being informed about different fertility
subjects like endometriosis, artificial insemination and in vitro fertilization
goes a long way in making the people directly concerned to be responsible for
their own fertility treatment. The point here is that fertility treatment is
team work involving you, your husband or partner and your doctor. If you work
as a team, you’ll be able to design a fertility treatment plan that will work
for you as a couple. So how do you begin your fertility treatment plan? Even if
you already have been through months or years of treatment, be assured that it
is never too late to begin a plan. You can regain control once you know what to
expect and begin to participate in the decisions about your treatment.
Let me quickly point out that you cannot expect the same
quality of treatment from every doctor or clinic, just as it is true of any
kind of service.
Before consulting the fertility expert, it is useful to know
what to expect. Things like what tests would be recommended, what the results
would mean, how long the workup would take, and how much it would cost. The
more you know about your treatment, the better you can work with your doctor.
In practice, I’m used to giving every couple an overview of fertility treatment
even before we start to discuss their options. This helps build up their
confidence. Most couples seeking
fertility treatment are usually of the opinion that if their doctor doesn’t
want to answer their questions or doesn’t tell them what to expect, they’re probably
seeing the wrong doctor. The first point I usually stress is the need to
appreciate that the goal of fertility treatment is to help you have your own
child. If you understand the factors necessary for making a baby, you will also
understand what factors your physician will evaluate during your fertility
workup.
There are key ingredients essential for fertility as far as
every couple is concerned. Basically, as a woman, your state of health must
allow you to safely carry a pregnancy and your male partner must be able to
produce and ejaculate functional sperm. If you are able to produce a healthy
egg, it must mature and escape from your ovary at regular or predictable
intervals and travel through your fallopian tubes toward your uterus. You must
know that as a couple, you should have intercourse at the right time. You must
be aware that the man’s sperm should be capable of traveling through your cervix
and uterus to the fallopian tubes to join with the egg, and that the sperm must
be able to penetrate the egg to effect fertilization. Then the fertilized egg
must be able to travel through the fallopian tube down to the uterus for
implantation. I won’t forget to mention that as a woman, your hormone system
and uterus must also be able to maintain the pregnancy.
It all sounds simple but it is actually quite a very
complicated process in which there could be a breakdown at any point that could
affect any of the fertility factors we discussed earlier. As a couple, you need
to be interviewed together, but the individual interview is also essential to
enable each partner feel free to reveal their closest held secrets such as
having had an abortion, a sexually transmitted disease, an illegitimate child,
for example. If either of you withholds information, the doctor may perform unnecessary
tests and it may take longer and cost more to identify your missing fertility
factors. Honesty and completeness pay off. I remember one woman who told me in
confidence about an abortion she had before she was married. Since I knew she
had been fertile at that time, I began looking for events that occurred since
then. When I learned she’d had a ruptured appendix a few years later, I
suspected the infection and surgery could have adversely affected her
reproductive organs. So I began to formulate a series of tests that would give
me definite answers.
Sometimes fertility history reveals obvious problems. For
instance, if you have only one or two periods a year, we could be dealing with Ovulatory
problems. If you complain of extreme pain during menstruation, it could
be Endometriosis.
If you’ve had one or more episodes of Pelvic Inflammatory Disease (PID),
then you may need to be checked for Tubal Blockage. All these require
different diagnosis and treatment approaches. Less obvious factors that can contribute
to fertility problem include previous abdominal surgeries, diabetes or a case
of childhood mumps, drugs and high blood pressure medications. To father a
child, a man must be able to produce and ejaculate good quality semen.
What I mean by good semen is one that contains large numbers
of normally formed sperm which can swim actively in a straight line. In
addition, semen should be free of infection. To deliver the semen to the woman,
he must also be able to ejaculate. This requires open passages from the
testicles to your penis and an intact nervous system for controlling the
ejaculatory process. If semen analysis is normal, it can be assumed that the
fertility problem lies with the woman’s reproductive system and attention will
be switched to diagnosing her problem.
On the other hand, if the Semen analysis reveals a
problem with the man’s fertility, then he would be advised to have a physical
examination to assess his general health and the condition of his reproductive
organs. I have come across cases in which a man had almost no sperm or zero
sperm in his semen. The best approach in such cases is to find out if this was
because the man was not making sperm or because his sperm could not get out
through his ducts. Based on examination findings, additional tests may be
required to detect if the man has ductal blockage, impaired ejaculation,
impaired sperm production, or a hormonal problem, or refer him to a urologist
for further evaluation and recommendations. But let me sound a note of warning
that discovering fertility problem with the male partner does not necessarily
guarantee that the female partner’s reproductive system is working well.
Actually in about 20 to 30 percent of cases, both partners
contribute to their fertility problems. There are dozens of cases in which the
man would have a poor sperm count and the woman would fail to ovulate. It is
essential to be certain where problems arise and treat appropriately.
As a woman, even if your Periods are regular, it
cannot be assumed that your Menstrual Cycle is working normally.
So what is often required is a combination of a review of your history, current
complaints, a physical examination to evaluate your general health and the
condition of your reproductive organs as well as laboratory tests to determine
whether or not you are ovulating and if your hormone levels are adequate. A
hormonal assay may be desirable in the initial workup because this may reveal
whether you are ovulating or not or give an idea of your egg quality. In
addition, an x-ray to obtain valuable information on the structure of your
fallopian tubes and uterus may be required. Many of these tests must be
performed at specific points in the monthly cycle.
Some fertility experts perform a post coital test to
determine if the “chemistry” between the partners is right. For instance, if
the wife’s cervical mucus is impairing or destroying the husband’s sperm, there
are a number of things that can be done to improve the situation.
The problem with this test is the fact that it is very
difficult to interpret i.e decipher what is normal or abnormal. An initial
workup usually takes two to four weeks and once the doctor has the results, you
can begin to discuss your options. Knowing the treatment time frame is useful
so you may appreciate how long it may take to achieve a pregnancy. With this
information you can assume more control over your time and money.
Sometimes couples wonder why the workup often takes several
weeks. Unfortunately, within one menstrual cycle we can try only a few things
at a time. It is for such reasons that a doctor cannot always tell you exactly
how long treatment will take or how effective it will be. Of course you do have
a right to know, however, what results to expect if the procedure is a “success”
or a ‘failure” because it is this knowledge that will provide the tools needed
to participate in the decision about what to try next.
Many people become discouraged with fertility treatment
because they often expect that it is in the first month or so that they will “become
fertile” and go on to make their own baby. It does not always happen like that.
Treatment may continue for 4 to 6 months regulating ovulation and improving
semen quality to acceptably fertile levels, yet the seventh, eighth and ninth
months may pass with no pregnancy in sight. This does not signify failure. If
it is considered that on the average, fertile couples have a 20 per cent chance
for pregnancy each month, while people who have been through fertility
treatment have at the most a 20 per cent chance too, then it can be appreciated
that you could easily take six months to a year to get pregnant, even if
everything is in perfect working condition.
Fertility treatment is a tremendous strain because the
question of whether you would or would not get pregnant is on your mind every
day. Just don’t get upset about it. Remember your plan? You try three or four
cycles and if you aren’t yet pregnant, you consider other options.
Credit: City People
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