Babies Tale

If you eventually visit a fertility clinic, you and your partner will be asked for details of your medical history: any past illnesses and any surgery. You will be asked questions about your sex life: how many sexual partners you have had, how often you make love, and so on. Many people find this an intrusion into their privacy, but the questions are all relevant.

A routine physical examination will be carried out on both partners. You will be examined to check that your respective reproductive organs are normal. For the man, this means inspecting the external genitalia and in particular the testicles for any signs of a varicocele (enlarged veins) or other abnormality. The woman will have an internal pelvic examination, during which the doctor will insert a speculum to hold the walls of the vagina apart so that she can view the cervix and take swabs for testing if she suspects a vaginal infection. She will also use her hands to feel the internal organs; this may enable her to detect problems such as fibroids, ovarian cysts or scarring from previous infections.

Tests Undergone by the Woman

One of the first tests for infertility is to find out whether the woman is ovulating, by using basal-body-temperature charts. At the time of ovulation there is a small but distinct rise in the body’s temperature, due to production of the hormone progesterone. This temperature spike can be measured by taking a woman’s temperature every morning on waking up. Many women find this to be a bothersome procedure. A three-month record should show

If you are ovulating and if your cycle is normal, but you may be asked to continue keeping a temperature chart much longer than this. Because temperature charts are sometimes difficult to interpret and are not always reliable, the woman will probably be given further tests to measure the level of hormones that control ovulation. Doctors may order a blood-progesterone test, a simple and painless way of measuring the level of progesterone when it reaches its peak at about day 24 in a 28-day cycle. If the level of progesterone is high, it is a good indication that ovulation has occurred.

The postcoital test may also pinpoint why a woman is not conceiving. The woman makes an appointment for the time of the month when she thinks she will be ovulating. The couple is asked to have sexual intercourse on the night before or the morning of the appointment. At the clinic, the doctor will take a sample of the woman’s cervical mucus from the neck of the womb for examination. The quality of the mucus-clear and slippery, or sticky and opaque-tends to indicate whether the woman has ovulated. By examining the mucus under a microscope, it is also possible to tell if the sperm are normal, if there are enough of them and whether the sperm are agglutinated (clumping together), which might indicate the presence of antibodies. If postcoital tests are repeatedly not very good, the next step may be to test the semen and mucus for antibodies to sperm that may interfere with sperm motility (ability to move).

An endometrial biopsy is a procedure that shows whether or not the woman has ovulated. It involves taking a small sample of the lining of the womb for examination. This is a minor surgical procedure, similar to a D&C (dilitation and curettage). The test should show if the womb lining is sufficiently primed by hormones to be able to receive the egg for implantation. If the woman is ovulating normally, the next investigation will be to see if the Fallopian tubes are clear,

Doctors will take an X-ray of the uterus and Fallopian tubes.

A dye is injected through the cervix and into the uterus, The dye passes through the womb, along the Fallopian tubes and into the pelvic cavity. This enables the doctor to see all the organs.

A laparoscopy is used to detect blocked or damaged tubes and other abnormalities of the womb or ovaries. Under general anesthetic, a small incision is made in the navel, and a laparoscope-a telescope-like instrument-is inserted. This instrument helps the surgeon to examine the organs in detail and assess the extent of any damage.

Sometimes a hysteroscopy is performed-an inspection of the inside of the womb with an instrument similar to a laparoscope. Ultrasound may also be used vaginally to assess the ovaries and womb.

Tests Undergone by the Man

The man will be asked to produce one or more sperm samples. This should be done at the outset, before the woman undergoes any major procedures. The man is asked to produce a sample by masturbation into a sterile container either in the clinic or at home. If he does this at home, he must deliver the sample to the clinic within I-I/2 hours. The sample is examined to see if the sperm are healthy, numerous and motile. Since one test is not always reliable, a poor result may mean he has to repeat the test.

Sometimes a man is diagnosed as subfertile on the basis of one test alone. Yet a single sperm count is very unreliable as an indicator of a man’s normal fertility. Sperm counts vary enormously from one act of intercourse to another, If all is well, this may be the only test the man has to undergo. If he has a very low or absent sperm count, however, he may undergo other tests to look for a cause. The sperm may also be examined at the postcoital test (see page 20), which may give some insight into why the sperm are not functioning properly.

Hormone tests may be carried out to check levels of testosterone, a male hormone. His doctor may perform a testicular biopsy. In some cases where the man has no sperm at all, or azoospermia, an operation may be carried out under general anesthetic to check that the vas deferens (the tube that transports sperm out of the testis) is not obstructed and to see whether there are any structural abnormalities.

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