Management Of Infertility

Infertility is the inability of a couple to procreate or bear children after one year of regular unprocteted sexual intercourse. The rate of infertility has been on the rise of late which is brought about by a wide range of physical and emotional factors.

 History Taking

It is important to take the history of both Males and Females together or separately. This should include developmental history including immunisation, milestones, e.g. puberty
, past medical and surgical history, frequency of coitus and mode of coitus. It should also include types of jobs of husband and wife and whether they live together or separately.

Specific questions must be asked from both males and females of any past infections, vaginal or urethral discharge or lower abdominal pains. Specific questions of past history of mumps should be asked in the males. Both partners should also be questioned for past history of diabetes or hypertension or drug abuse.

Physical Examination 

Both male and female should be examined for any congenital abnormality including undescended tests in the male, imperforate hymen or any other disability in the females, should also be screened for evidence of fibroids and all other factors that may be responsible for infertility.

Counselling

Physical examination is followed by counselling of the couple. This should include the physical aspect of sexual relationship, sex, education and detecting any sexual dysfunction.

During the first counselling, some very important points are stressed. These include:

1. That fertile sperms should enter the vaginal at the time of ovulation.

2. Good secretion (i.e. egg white) from the cervix are required for sperms to enter the uterus.

3. The tubes have to be open.

4. The lining of the uterus must be in the right condition for the egg to implant and pregnancy to start.

It should be stressed during counselling that getting pregnant is a function of both males and females. The mind of the male should be disabused about the fact that fertility is only a function of the female, i.e. referring to fruit of the womb. The man has to first deposit viable spermatozoa before pregnancy can be achieved. Both partner should therefore be encouraged to take joint responsibility for achieving their aim of having a child.

One of the methods is the use of the Ondo Chart. Both Parties are encouraged to look at the chart together. Other methods include recording it on a chart. The most reliable method is however the Billings Method of Ovulation and the filling of the Ondo Chart.

It is important to reassure the couple and continue to encourage them to use the natural methods for about a year unless gross abnormalities have been discovered during physical examination. If these however fail, it is necessary to proceed to investigation.

Investigation of an Infertile Couple

The investigation should involve those for the husband and wife. The couple should be made to understand that both of them have to go through the medical tests together.

It is also better to start from the non-invasive tests before proceeding to the invasive tests. The non-invasive tests are those that would not disturb the physiology of the body.