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Dr Miriam Stoppard's Health Focus : INFERTILITY, PART 2 - INVESTIGATING THE PROBLEM.

THE investigation of infertility may try your patience and resolve. It may even humiliate you.

Whichever partner is found to have low fertility will feel threatened and guilty.

Be prepared to be long-suffering and very generous. And please see the counsellor affiliated to your Fertility Centre for guidance.

INVESTIGATING INFERTILITY

TRACKING down the cause of infertility proceeds logically.

PART ONE: YOUR GP - ONE couple in six consults their doctor about infertility. Your doctor first assesses how healthy you both are and will ask about your sex life.

The woman will be asked for dates of her last six periods to establish she's menstruating regularly.

If further investigation is needed, the couple will be referred to a special fertility clinic and further tests will be done there.

PART TWO: A SPECIAL INFERTILITY CLINIC - WOMEN may be asked to keep an ovulation temperature chart and will have a blood test to check that ovulation has occurred.

Lovers put to the test

CHECKING ON OVULATION

IF your doctor suspects there's a problem with ovulation, you'll be tested for the level of progesterone in your blood on day 21 of a 28-day cycle, or seven days before an expected period if your cycles are usually shorter or longer than 28 days. This is because progesterone levels rise after ovulation anda high level will indicate that if you're ovulating.

Ovulation temperatures

TEMPERATURE rise (upper line in graph) indicates ovulation. Lower line shows failure to ovulate. HER partner is asked to provide a semen sample. OIFa man's sperm are normal, the woman will then be offered a laparoscopy if she's ovulating, and may be offered an ultrasound scan if pelvic abnormalities are suspected. Once the cause of infertility is pinpointed a suitable treatment will be suggested.

CHECKING MALE INFERTILITY

Sperm assessment

YOUR doctor will arrange for preliminary tests on your semen before making more detailed investigations of your fertility. The semen samples are examined by a trained technician, using a microscope and a computer-assisted semen motility analyser.

Sperm tests

SPERM tests are performed to assess if your sperm are capable of swimming to and penetrating your partner's egg.

IN the sperm invasion test the interaction between your sperm and your partner's cervical mucus is examined under a microscope. If sperm are unable to cross into the mucus or cannot move through it properly, the finding doesn't itself indicate whether the problem lies with the sperm or the mucus.

THE crossover sperm invasion test is performed to answer that question.

This uses exactly the same procedure as the sperm invasion test - but first, your sperm and normal mucus from a donor female will be used, and second, the normal sperm for a donor male will be combined with your partner's mucus.

These may reveal the problem but, if not, further tests such as the egg penetration test may be necessary.

THE egg penetration test examines the potential of sperm to fertilise an egg. The test involves introducing the sperm to hamster eggs (yes, I know it sounds strange, but read on) and measuring how well the sperm penetrate and fuse with them.

The use of hamster eggs mean that your partner doesn't have to go through stressful IVF treatment in order to provide eggs for testing. There's no danger of an embryo resulting from the fusion of sperm and hamster eggs.

CHECKING FEMALE INFERTILITY

Laparoscopy

A SLENDER telescope that's equipped with fibre optics, a laparoscope is about the width of a fountain pen.

It can be inserted through a tiny incision in the navel to view the abdominal cavity directly.

In addition to offering the surgeon a superb view of the organs, high-quality videos can be taken through the laparoscope for later reference.

Laparoscopy allows the normality of the reproductive organs to be assessed under direct vision.

Blue dye is injected through the cervix to check if the fallopian tubes are open, when the dye can be seen trickling out from the ends of the tubes if they're clear.

Laparoscopy is often timed for the second half of the cycle to confirm ovulation has happened.

HSG

HSG is usually reserved for women found to have damaged fallopian tubes via laparoscopy, or if doctors suspect there's something wrong with the uterus - say, a cyst.

HSG is an X-ray picture of the uterus and the tubes and can show up problems within the cavity of the womb and within the tubes.

Dye is useful for checking the fallopian tubes as it will only enter and travel through open tubes, thus showing up any damage, distortion or complete blockage. The injected dye is monitored on an X-ray screen. HSG stands for hysterosalpingography.

Endometrial biopsy

IN this procedure a tiny amount of the endometrium (the uterine lining) is removed and then examined for any changes.

An endometrial biopsy is performed in order to assess whether a woman's hormones are bringing about normal alterations to her endometrium during the second half of her cycle in preparation for conception.

When the hormones are balanced correctly, there's an increase in the production of progesterone, which thickens the endometrium.

If progesterone's being underproduced, the uterine lining won't develop sufficiently for an embryo to implant. If there's little or no alteration, then fertility drugs are an option.

Ultrasound scanning

USING ultrasound scanning to check the development of the ovarian follicles, doctors can track the growth of follicles and the release of the ovum or ova at ovulation.

Ultrasound is particularly useful during artificial insemination and IVF treatment, when knowing the precise time of ovulation is crucial.

Artificial insemination and IVF are only done under ultrasound monitoring.

FOR further reading, Conception, Pregnancy And Birth, by Dr Miriam Stoppard, is published by Dorling Kindersley at pounds 17.99. To order, tel: 01279-623946 quoting 180771. Miriam Stoppard.
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Title Annotation:Features
Author:Stoppard, Miriam
Publication:The Mirror (London, England)
Date:Jan 13, 2000
Words:958
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