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Babies are Made - The Basics (Page 4)
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Semen Analysis
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In order to understand why pregnancy doesn't occur
, we need to examine the four critical areas which are
needed to make a baby - eggs, sperm, fallopian tubes,
and the uterus. The tests, which often seem endless,
will actually fall into one of these areas. In 40% of
cases, the problem will be with the male, in 40% with
the female, and in 10% both partners will have a problem.
In some cases, about 10%, no cause can be identified
(unexplained infertility) even after exhaustive testing.
Before starting with tests, the doctor takes a detailed
medical history from the couple, and also performs a
physical examination for both of them, to determine
if this can provide clues as to the cause of the problem.
The doctor will need to find out details about your
menstrual cycle, as well as your sexual habits and past
history of surgery or illness, so you should be prepared
to answer these questions. Many clinics give patients
a form to fill out, so that they can provide all this
information. A physical examination can also provide
the doctor with useful information, and he will look
specifically for important clinical findings such as
abnormal hair growth, excessively oily skin, or the
presence of a milky discharge from the breast.
However, for most couples, investigations are needed
to establish a diagnosis. These specialized tests constitute
the infertility workup and they can be completed efficiently
in one month . Timing the procedures properly during
the menstrual cycle is important and we have found the
following strategy useful in our practice.
The first day the bleeding starts is called Day 1,
and the semen analysis can be done at this time. The
wife's blood hormonal tests for Prolactin, LH, FSH,
TSH can be done between Day 3-5 of the cycle; followed
by a hysterosalpingogram (X-ray of the uterus and tubes)
between Day 5-7. Ultrasound for ovulation monitoring
is done between Day 11-16 ; and this is used for timing
the PCT (postcoital test) as well, during which time
the cervical mucus is assessed also. A serum progesterone
level is then measured on Day 21, about 7 days after
ovulation , and this provides information about the
quality of ovulation. The laparoscopy can be performed
in the same month (Day 20-25) ; and can be combined
with an endometrial biopsy if desired.
With this strategy, time is not wasted, and couples
can be reassured that a possible reason for the cause
of the infertility , if it exists, will be detected
within one month.
The workup should not stop when a problem is discovered
- it is still important to complete the testing, since
it is possible that infertile couples may have multiple
problems. Many diseases, such as pelvic inflammatory
disease ( PID) which can cause the tubes to get blocked,
can be "silent", so that the patient may have
absolutely no signs or symptoms.
A single test abnormality does not necessarily mean
that a problem exists and the test may need to be repeated,
to confirm that it is a persistent problem.
Sometimes it can be difficult for patients to come
to terms with the fact that there is a major problem
which presents a significant hurdle to getting pregnant.
The truth can be bitter , but it’s far better
to face up to it and deal with it, rather than live
in a fool’s paradise ! With today’s advanced
reproductive technology, we can always find a solution,
no matter what the problem – but remember that
unless you can intelligently identify the problem, you
cannot find a solution !
Unfortunately, it is very common to find that tests
are done piecemeal - or sometimes, not done at all.
Often treatment is started before coming to a diagnosis.
Conversely, some doctors take so long to do the tests,
that patients get fed up - after all, they want treatment!
The couple must be seen together and the first test
which should be done is a semen analysis. Sadly, sometimes
the wife will have undergone innumerable tests (sometimes
repeatedly !); and the husband's semen analysis (where
the problem lies) has not been done even once.
It is only after the workup has been completed , that
a treatment plan can be formulated - and you will now
need to make decisions about treatment options.
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Babies are Made - The Basics (Page 4)
Next page: Testing
the Man - Semen Analysis
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