At the Infertility Clinic

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The brief review above of the common causes of infertility covers conditions found in about 30 per cent of couples who submit to full investigation at an infertility clinic. Of the other 70 per cent, no obvious cause of their trouble can be found.

When a couple attends the infertility centre the exact investigations required depend on the doctor's assessment of the situation. The following are a few of the tests and examinations which may be used.

Health Record and Medical Examination

A carefully planned set of questions is asked to find out about the past health record of the couple and to check if there are any difficulties about their sexual relations. Perfect frankness is best at this stage. The woman's menstrual history is checked and any previous pregnancies are enquired after in detail in case there has been previous infection. Both partners have separate medical examinations to check for any obvious abnormalities of the genitals. If any abnormalities are found they are treated. If there are none, some of the following tests may be performed.

Post-intercourse examination of the woman may be performed in order to check on the semen left by her husband and its activity. If possible the test should be within twelve hours of intercourse but can be done later. Hence intercourse should be late the night before attending the clinic and the woman should not wash, bath, or douche herself afterwards. A small specimen is painlessly taken from the cervix and examined under the microscope for active sperms. If present they rule out most male causes of infertility and help to clear the cervix from being the cause of the childlessness. If no active sperms are seen, it is wise to repeat the test closer to the time of intercourse.
Examination of the Semen
If both the above tests fail to show active sperms, the husband should produce a fresh specimen for the laboratory to examine fully. There are many variations in numbers, type, and mobility of sperms and only an expert can decide on the variations available. The fertile man has millions of sperms in each teaspoonful of semen.
Basal Temperature Charts
To check if eggs are being made, the woman may be asked to keep a chart of her early morning temperature for some months. The temperature under the tongue should be taken with a clinical thermometer every morning before rising, drinking tea, and washing teeth. These temperatures are recorded, and experts can sometimes tell by the cyclical change if an egg is shed and when in the cycle this happens. They can then advise the woman about the best time for fertilisation to occur.
Tubal Insufflation
A small tube is led into the uterus, and air or carbon dioxide is passed along it. The gas goes into the uterus and along the Fallopian tubes. If these are not blocked, it will pass out of the outer ends of the tubes into the abdominal cavity. This escape of gas may be noted by the drop in pressure of the gas or by listening to the bubbling through the abdominal wall with a stethoscope. This investigation may be done on the conscious patient in an out-patient department for it is rarely painful although often uncomfortable. Some doctors prefer to perform the tubal insufflation under a general anxsthetic and to combine it with other tests.
Hysterosalpingogram
By passing into the uterus a fluid which is not transparent to X-rays, a `picture' can be obtained of the cavity of the uterus and the Fallopian tubes. Further, if some of the material `spills' out of the end of the tube into the abdominal cavity, this is good proof of the patency of the tubes. All these changes can be seen on the X-ray screen and can be recorded with X-ray films.

If blockage occurs, the exact site is shown so that if the surgeon thinks an operation is feasible, he knows just where to cut. This investigation is usually done in the X-ray department and takes about 20 to 30 minutes. It is not usually very painful but if it is so, an anxsthetic would be used.
Curettage
If the woman is admitted to hospital for a curettage, this has to be in the later half of the menstrual cycle. An anxsthetic is given and a full pelvic examination is made. After dilatation a few strips of the lining (endometrium) are taken and, by examination of these under a micro-scope, the investigator can tell if the patient is making eggs. Certain infections of the pelvis, e.g. tuberculosis, might also be detected from such curettages. This examination means only three or four days in hospital.

Infertility is an increasing problem. Forty years ago a couple accepted barrenness as inevitable, a condition about which nothing could be done. Now couples are wanting to know more about themselves, and modern treatments can sometimes help them to have a family.

Source :
Polulation Bulletin.

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