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.

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common problems associated

Fibroid Symptoms
*          Long menstrual period:

            Period may last more than seven days and menstrual flow may be very heavy. Heavy menstrual flow can sometimes lead to anaemia.

*          Pressure on other organs: Large fibroids may press on organs in the pelvic
         
            - A basin-shaped cavity in the lower abdomen, containing the bladder, bowel, and reproductive organs.


            - If fibroid press on the bladder: A woman may feel the urge to urinate frequently. She may pass only small amounts of urine and she may feel as though she has not completely emptied her bladder.
         
            - If fibroid press on the bowel, she may feel constipated suffering from difficult, painful, or infrequent movement of the bowels, or full after eating only a small amount of food.

         - If fibroid press on one or both ureters (the tubes connecting the kidneys to the bladder). They may partially block the flow of urine. A woman may not be aware of this, because it often isn’t painful. Over time, however, this kind of blockage can lead to kidney infections or other serious kidney damage.

*         Pelvic Pain

            The pressure of large fibroids on other organs may cause pain in the pelvic. Sometimes, if fibroid do not get the blood flow they need to sustain themselves, they degenerate or die. This may cause severe pain lasting for days or weeks. Pain may also occur if the stalk of a fibroid twists, cutting off blood supply to the fibroid. Rarely, a fibroid may become infected and cause pain.

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Fibroid Causes

Fibroid Causes

Fibroid are growth of tissue that are usually found in the wall of the uterus, or womb. They are made of a mixture of muscle tissue from the uterus and threadlike fibers of connective tissue. Although they are called tumours, fibroid are not cancerous.

Fibroid are very common. They occur in 2 or 3 out of every 10 women over age 35.

They occur most often in women between ages 30 and 50, although women in their 20s sometimes have them. It is common to have more than one fibroid. Some women may have as many as a hundred. Fibroid can be as small as a pinpoint or as large as a basketball. They are usually round or oval in shape, like a ball or an egg. Their texture is firm like an unripe peach.

Fibroid can grow in different parts of the uterus. They are named according to which part of the uterus they are found.

Fibroid that grow inside the wall of the uterus are called INTRAMURAL FIBROID. They are the most common type of fibroid.

Fibroid that grow outward from the wall of the uterus into the abdominal cavity are called SUBSEROUS or SUBSEROSAL FIBROIDS.

Fibroid that grow inward from the uterine wall, taking up space within the cavity of the uterus, are called SUBMUCOUS or SUBMUCOSAL FIBROID.

A fibroid that is attached to the uterus by a thin stalk is called a PEDUNCULATED FIBROID.

WHAT CAUSES FIBROID

A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumour cell and starts to grow and multiply. Heredity may be a factor. It is thought that a muscle cell in the uterus may be “PROGRAMMED” from birth to develop into a fibroid sometime-perhaps many years-after puberty (the start of menstrual periods).

After puberty, the ovaries produce more hormones, especially oestrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.

SYMPTOMS OF FIBROID

For many women, fibroid cause no problems. More than half of women with fibroids do not know they have them until their doctor tells them so.

DIET:

Stay away from caffeine. A high fiber diet is good for taking the excess estrogen from your body through the colon, if not it will re-enter your bloodstream. Stay away from conventionally processed meals, beef especially. Eat organic meat.

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