Fertility Care – Details by Issues
Knowing Why: Root causes of infertilityInfertility can be caused by a single issue or a culmination of a few issues. In seeking treatment, it is important to help couples identify the root cause of infertility. This enables possible options to be drawn out and via constructive discussions, help couples derive solutions that they are comfortable with. Common ConditionsThe following are some common conditions that could impede a couple’s chance to conceive. Female AgeWomen are born with a lifetime supply of eggs, and these gradually decrease, in both quality and quantity, with age. The number of eggs that a woman is endowed with at the point of her first menstrual cycle averages 300,000-400,000. As she grows older, the number of eggs decreases. By age 30, the egg count stands between 39,000-52,000, and by age 40, it drops to between 1,200-9,000.In determining fertility, a woman’s ovarian reserve must be of a level that facilitates pregnancy.Test(s) we runAnti-Mullerian Hormone (AMH) TestThe Anti-Mullerian Hormone (AMH) test is a laboratory test conducted to assess a woman’s ovarian reserve or egg count. AMH is a hormone secreted by cells in developing egg sacs or follicles. The level of AMH in a woman’s blood is generally a good indicator of her ovarian reserve.How we treat35 – 45 years: In vitro fertilisation (IVF) | Preimplantation Genetic Testing (PGT) | Endometrial Receptivity Assay (ERA)Above 45 years: In vitro fertilisation (IVF) with donor eggs |Preimplantation Genetic Testing (PGT) | Endometrial Receptivity Assay (ERA) Sperm CountInfertility does not only affect women. In 40 per cent of couples with infertility, the male partner is either the sole cause or a contributing cause of infertility. This is most often due to problems with sperm production or sperm delivery.In male fertility, a normal semen analysis result would show a sperm count of at least 15million sperm per mL, with at least half showing forward progressive movement.Test(s) we runSperm Analysis TestA Sperm Analysis Test is a laboratory test conducted to accurately measure the number of sperm, their motility (ability to move), their morphology (size and shape), and the volume and consistency of the ejaculated semen sample.How we treatNormal: Ovulation Induction | Time-Sexual IntercourseAverage: Intrauterine Insemination (IUI)Poor: In vitro fertilisation (IVF) | Intracytoplasmic sperm injection (ICSI)Azoospermia: In vitro fertilisation (IVF) with donor eggs | Intracytoplasmic sperm injection (ICSI) Fallopian Tube ObstructionCommon reasons for blocked fallopian tubes include scar tissue, infection, and pelvic adhesions. If a fallopian tube is blocked, the passage for the sperms to get to the egg, as well as the path back to the uterus for the fertilised egg, is obstructed.Tubal factor infertility accounts for about 25 to 30 per cent of infertility cases. The condition includes cases of completely blocked fallopian tubes, and cases where just one tube is blocked or scarring narrows the tubes.Test(s) we runHysterosalpingogram (HSG) X-rayA Hysterosalpingogram (HSG) is a procedure that uses an X-ray to look at the fallopian tubes and uterus. It usually takes less than five minutes and the patient can go home the same day.LaparoscopyLaparoscopy is a surgical procedure that allows a doctor to see inside the body. When the procedure is part of fertility testing, the doctor is evaluating the structures of the reproductive system, including the ovaries, fallopian tubes, and uterus. The procedure is normally conducted as a daycare procedure.How we treatIn vitro fertilisation (IVF) Uterine FibroidsUterine fibroids are benign lumps of tissue which grow in the muscular part of the uterus. They are very common; up to 40 per cent of women have at least one fibroid, and they tend to increase with age. They are not cancerous or otherwise at all harmful to health.The vast majority of fibroids does not affect fertility and does not need any treatment. The critical aspect affecting fertility is whether the fibroid is distorting the lining of the uterus or if it is located inside the uterus itself.Test(s) we runUltrasound ScanAn ultrasound scan is used to confirm the presence of uterine fibroids. It uses sound waves to get a picture of the uterus to confirm the diagnosis and to map and measure fibroids.How we treatLaparoscopic Surgery | Myomectomy Polycystic Ovarian Syndrome (PCOS)Polycystic Ovarian Syndrome (PCOS) occurs when the ovaries develop numerous small collections of fluid (follicles) and fail to regularly release eggs resulting in irregular menstrual cycles.As many as 25 per cent of women of childbearing age have PCOS, but most do not even know that they have it until they begin trying to get pregnant.Test(s) we runUltrasound ScanAn ultrasound scan can indicate the presence of these follicles.Blood TestsBlood tests can reveal changes, with higher levels of testosterone and Luteinising Hormone (LH) (often in conjunction with a higher LH to Follicle Stimulating Hormone (FSH) ratio) found compared to those of women with normal cycles. These levels may vary considerably and are best assessed early in the menstrual cycle (if there is one). Blood tests may also indicate a change in blood glucose and insulin levels.Pelvic ExamA pelvic exam is also conducted to confirm the diagnosis.How we treatLaparoscopic Ovarian Drilling (Ablation) | Ovulation Induction | In vitro fertilisation (IVF) This blog is intended for educational purposes only. All contents here is general in nature and does not take into account your personal circumstances. Please consult with your health care professional to ensure you get the right diagnosis and treatment. (Everybody has a chance to build a family) by Dr Navdeep