INFERTILITY SURGERY

The investigation of infertility is a complex procedure which can be expensive, tedious and time-consuming. The couple going for investigation should be aware of this and also be very patient. The basic investigations that you would go through during the course of management are as follows.


A. Husband's sperm analysis

This is a simple test but essential. Roughly one third of the infertility is due to male causes.


B. Establishment of successful sexual intercourse

This is done mainly from history and internal examination. The post-coital test will confirm that sperm has been deposited in the vagina and is the indication of completion of sexual intercourse.


C. Cervical factors

Cervical mucus quality is an important media for sperm transport into the uterus. Examination involves extraction of the mucus between the 12th to 14th day of the cycle a few hours after coitus. The mucus is examined under the microscope and the sperm quantity, mobility and quality is established. At the same time, gross infections are ruled out. If necessary, a Pap smear, colposcopy or even cultures of mucus are taken to exclude disease which may inhibit mucus quality, or prevent sperm passage through the mucus.


D. Ovulation

One of the commonest reasons for failure to conceive is the failure to ovulate or weak ovulation. The simple but rather tedious method to establish this by the temperature chart. The second half of the cycle has an elevated temperature should you be ovulating. However other complementary methods should be used to fully confirm this. Blood tests can be done on your hormone progesterone which remain elevated after you ovulate. This is taken usually on the 21st and 25th day. The ultrasound scan can also be used to track the growth of the follicle up to the time it releases the egg. However this involves very frequent visits to the clinic during the cycle.

These methods are also used to confirm ovulation when you are on treatment. In cases where you fail to ovulate, a cause may have to be established. More detailed analysis of your body hormones and other test may have to be done.


E. Abnormalities in the uterus

A preliminary internal examination usually gives us a good indication of the size, shape and position of the uterus. If this is difficult, an ultrasound examination is required. Growths such as fibroids may be the cause. However in order to evaluate the internal; cavity of the uterus, either a x-ray called (hysterosalpingography) or a hysteroscopy is performed. Hysteroscopy is the evaluation of the cavity with a telescopic device shaped like a long pencil. It can show small growths or disease inside which are missed by other methods. At the same time a biopsy of the lining can be taken to confirm ovulation or evaluate any suspicious growth. Disease within the cavity not only interferes with sperm transport but also prevents the proper implantation of the embryo.


F. Abnormalities of Ovaries, Tubes and Uterus

Finally a major operation called an abdominal laparoscopy may have to be considered. This is a procedure whereby these organs are examined through a telescopic device inserted into your abdomen while you are under general anesthesia. It helps by:-

• Demonstrating that the ovary is positioned correctly
• The fimbriae of the tubes are not diseased and so can retrieve eggs during ovulation
• That the tube is not obstructed and can allow the free passage of the sperm
• That the uterus has no further disease on its outer surface
• Common diseases causing problems would be endometriosis, and adhesions or infections.


Cautionery note:

• Despite all these tests, there are many couples who are supposedly normal and yet cannot conceive
• The investigation may take as long as one year of repeated visits to the clinic

More complicated procedures and hormone test may have to be done if the above tests are still unsatisfactory. Couples who neeed highly specialized treatment may still be referred to special clinics such as those that conduct test-tube baby programmes