Thursday, September 23, 2010

8.30 How To Get a Baby Despite Infertility & Have Fun

Physician's Notebooks 8 - -See Homepage

30. Infertility - Update 07 April 2018
When a woman is ready to have a baby, a good idea is have a go at what I call the Good College Try each month – coitus on the 3 days before expected ovulation and, if after 6 months she has not got pregnant, consider it infertility in one partner.
   First question for a monogamous duo: Is it me or he? A look back at partner history helps because most persons do not change fertility status during baby-making years unless they develop disease or have surgery.
Did the man ever get any woman pregnant? If Yes and he is younger than 50, he is probably not the problem. But check his ejaculate sperm and semen by expert. It is simple, inexpensive and crucial. And do not depend on one abnormal semen sample for the sperm test: results vary day to day. The man should not ejaculate or take medicine for at least 3 days before the test and the semen should be collected at testing place by masturbation into cup (wife or partner may assist masturbation but not orally). Sample should be tested within 1 hour. If it is within normal limits, the semen and sperm are OK.
   Semen volume, pH, macro and micro inspection; number of sperm per cubic millimeter, motility evaluation and percent of abnormal forms are checked. Sperm count above 60 million is OK, 20–60 million is considered low for fertile male but rarely a problem in practice, 10–20 million is borderline and may be cause of male infertility that is helped by sperm concentration technique and by Artificial Insemination. Below 10 million is problem, and zero sperm count means mission impossible. Low sperm counts should be rechecked several times because even a single good sperm count in a sea of low ones suggests remedial cause.
If semen test is consistently abnormal, female partner should not have invasive or expensive infertility tests. Male testing may also involve chromosome analysis, CT or MRI scans, biopsy of testes and x-ray dye test of vas deferens. While this is going on, female partner should be doing ovulation detection.
   “Am I ovulating or not?” “Am I ovulating regularly?” Basal Body Temperatures record should detect ovulation. If ovulation does not come regularly each month and there is no reason to suspect uterine tube disease and obstruction, a trial of ovulation drug may give pregnancy.
   Normal ovulation and normal male partner having regular coitus with no success suggest uterine tube blockage due to pelvic inflammatory disease from infection or endometriosis, or else fibroid tumor distorting cavity of uterus. Imaging of uterine tube and test of tube blockage should be done. When infertility is found to be from uterine fibroid, and uterine tubes test normal, removal of the local fibroid may result in pregnancy. Surgery for uterine tube disease has low success rate, and today the IVF procedure – harvesting ovum via laparoscope, fertilizing with mate’s sperm, and implanting early embryo in uterus via vagina – is an alternate solution for the woman with uterine tubal-blockage infertility.
   Surrogate male sex partner is an idea arising in case of a couple where all infertility tests are normal in both partners and no pregnancy arises despite normal coital frequency with good timing, and while the female is below age 45 and tests show possibility of fertility. There is a gray area of infertility where a woman develops antibody against her husband’s semen and/or sperm. Artificial Insemination (AI) is an option here.

 END OF CHAPTER. To read next now, click 8.31 Avoid Pregnancy/Get a Good Lovelife

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