Clinical Assessment of Infertility

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An Infertility workup should be started after 1 year of unprotected regular sexual intercourse in couples in whom the female partner is less than 35 years and after 6 months in couples in whom the female partner is more than 35 years. But infertility workups can be started earlier in women who have a known risk for inferitly - such as endometriosis, irregular menstrual periods and a history of sexually transmitted diseases, especially chlamydia.

Infertility investigation requires probing into the minutest physical and psychological details. Management therefore needs sympathy, compassion and a great deal of tact on the part of the doctor.

It is necessary that the couple should be first spoken to together and then again separately. This is so that each is free to reveal anything they should wish to in complete confidentiality.

Knowing the details of the female reproductive organs, and how pregnancy occurs go a long way in understanding the different causes of infertility.

Clinical Assessment of Both the Partners for Infertility

Clinical assessment and a thorough history should be taken before the couple is subjected to investigations, both invasive and non-invasive. Certain points are to be especially noted:

  • Age of both the partners: A woman above the age of 40 years and closer to menopause have less than half the fertility potential and a lower pregnancy rate of a woman of 20 years. And a man above the age of 40 years can also show a lowering sperm count, although he can father children for his entire lifetime.

  • Previous children: If one of the partners has children from a previous union, he or she can be assumed to have the potential to get pregnant again.

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  • Birth Control: If the couple has practiced birth control, especially oral contraceptive pills or used intrauterine contracetive devices (IUCD) at any time, then these have to be taken into account. OCPs can cause anovulation, especialy if taken over a long time and IUCDs can cause infections of the reproductive tract.

  • Duration of the present Union: If their occupations separate them for any duration of time or if they have been together for less than 6 months, and the age of the female partner is less than 25 years, then tests to investigate the cause of the infertility may be delayed till the couple have been together for at least 1 year.

  • Frequency of intercourse: Coitus or sex must occur every 48 hours from the 8th to the 18th day of the menstrual cycle for an optimum chance at pregnancy. Too frequent coitus however is rarely a cause for infertility. Infrequent sex or coitus is more likely to cause infertility.

  • Pain during Intercourse: Many women avoid having sex or have irregular intercourse due to vaginal pain and may complain of infertility.

  • Coital history : A couple needs to have regular coitus to avoid infertility. Difficulty in sexual coitus due to conditions like vaginismus, impotence and erectile dysfunction can cause infertility.

  • Menstrual history: A regular menstrual cycle with normal blood flow indicates regular ovulation. Since lack of ovulation accounts for about 30% of all causes of infertility, the history of regular periods is an important pointer to the woman's fertility.

  • Male partner's Occupation: Constant heat can lower the sperm count. So occupations that can cause the male partner to drive long distances (sitting for a lng duration can increase the temperature in the scrotum)can cause infertility. Pesticides and certain anesthetic drugs can also lower the sperm count.

  • Previous illnesses and Operations: The cause of infertility can be due to an operation near or on the genital tracts or if either of them ever had any infections, especially infections by the chlamydia or gonococci (gonorrhea) organisms.

  • Medical history of both Partners: Certain conditions like diabetes, high blood pressure, thyroid diseases can lead to infertility or low fertility.

  • Lubricants: Sometimes when coitus or sex is difficult due to a dry vagina, many couples use lubricants like paraffin or lanolin. Many of these lubricants have a toxic effect on sperm and can cause infertility.

  • Miscellaneous: Drugs, certain medicines, alcohol and nicotine can lead to infertility if taken in excess.

The causes of female infertility are very different from the causes of male infertility and require different types of tests for an accurate diagnosis.

The treatment procedures of the male as well as the female partner are also different.

The aim of treatment is to remove any of the identified factors causing infertility. Most couples appreciate a description of the physiological process of fertilization and conception.

A sympathetic response to their difficulties goes a long way in decreasing the stress involved in visiting a doctor for treatment.

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