Fertility

Some couples have trouble getting pregnant and they need help!

There are many reasons for infertility including female and male causes.

All infertile women need a systematic investigation and targeted swift treatment to achieve success.

A comprehensive history can give an indication why some couples may have fertility problems. A past history of:

• Menstrual problems.
• Pelvic infections (STD/PID).
• Polycystic ovarian syndrome etc.

The main causes of infertility are:

• Failure of ovulation.
• Male factor (semen abnormalities).
• Tubal disease (blocked fallopian tubes).

All of these causes can be investigated and treated with good results.

Failure of ovulation

Causes for anovulation can be identified by performing:

• Serum progesterone levels (to confirm anovulation).
• Endocrine blood screen (to identify a cause).
• Pelvic ultrasound scan (to identify ovarian disease).

The majority of anovulatory women will respond to ovulation induction with Clomid (70%). Some women may also require Metformin (hypoglycaemic drug).

Occasionally some women may require gonadotropin injections.

Male factor infertility

Abnormalities of semen analysis is the second most common reason for infertility and should be performed on all infertile couples.

If a major sperm test abnormality were found these couples would be referred to specific IVF specialists that can assist even if the male is Azospermic (no sperm).

Tubal Disease

When all the initial investigations are normal, it is important to assess the patency of the fallopian tubes. Women who have had a pregnancy in the past can have tubal patency tested using specialised ultrasound techniques.

Women who have never been pregnant should have a laparoscopy and dye studies.

The laparoscopy can identify pelvic problems causing infertility.

Injection of dye through the cervix can confirm patency of the fallopian tubes.

Women with blocked fallopian tubes would be referred for IVF treatment.

Unexplained Infertility

When no problem can be identified with any of these tests, couples would be referred for assisted fertility care. This usually involves initially in utero insemination (IUI). If this fails they would progress to IVF or sperm injection treatment (ICSI).

It is wonderful that the majority of women will respond to basic gynaecologic infertility care.

If complex fertility care is required I would seek the assistance of specialists from both Melbourne and Monash IVF centres.

High quality fertility care requires:

• A systematic assessment of infertility.
• Appropriate investigations.
• Ovulation induction.
• And timely involvement of fertility experts for difficult cases.