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.
