A woman with infertility will be asked to do certain simple diagnostic tests to enable the clinician to trace and pin point the probable cause of her inability to get pregnant. The treatments to be employed could be non surgical, and surgical.
Non surgical : These may include:
*blood tests to check the hormone levels
* a smear test to check the health status of the cervix
• LH surges from urine assays
• A basal body temperature test (BBTT): This ascertains if a woman is ovulating; as the body temperature rises slightly at ovulation. There is continuous monitoring, using daily charting for 1month. This can be measured by using special thermometers which would measure her temperature orally or vaginally.
• Ultrasound scans : to look out for abnormal growth or shape like fibroids, cysts in the uterus and ovaries. A clear and distinct picture of the areas in question are obtained, and this procedure is very effective and with very little discomfort.
• An endometrial biopsy : which involves the removal of a piece of the uterine lining. This enables the doctors to know if eggs are being released, or corpus luteum is producing enough progesterone. The picture obtained from the smear using a specialized staining technique used, shows a definite structure of the uterine linning . This is the next step if the temperature charting is conclusive.
• A post coital test shows the state of the vagina mucous post intercourse. This is done during the woman’s fertile days and less than 12hours post intercourse. It shows if the man’s sperm can survive in the female’s mucous. This test would show immediately if there is any hostility to the sperm, which has been deposited in the vagina.
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Surgical :
• A Laparoscopy: which checks for the presence of ovarian or fallopian tube scarring or endometriosis. A laparoscopic tube is inserted into the female uterus, via the abdominal cavity, with special light. This checks for scar tissues and if there are any, they may be removed immediately.
• A Hysterosalpingogram (HSG) : This tes is not as common now, as there are more definitive and easier tests that can be done. Tthis is an x-ray examination of the woman’s fallopian tubes. A dye is flushed through the tubes to assess the flow and x-ray taken. This checks whether tubes are open or blocked. It also checks for fibroids, abnormal structures, endometrial polyps (growth), tumors etc. the process clears away any tubal blockage and restores the woman’s fertility. This test is harmless, but may give false positives and negatives.
• A hysteroscopy : is more recent and reliable diagnostic surgery. It involves the exploratory intervention, which is superior to the HSG, and involves the use of sophisticated and accurate, microscopic lenses, to view all the reproductive areas of the female anatomy.
It is important to know that in many cases, medications are indicated while in other cases surgery or other form of treatment may be required. If medications are not useful, and surgeries not appropriate, other specialized techniques are offered.
Medications to solve hormonal problems and ease infections in woman may be offered and lastly surgery to repair reproductive organs may restore the woman’s fertility.
Possible treatments with drugs: fertility drugs can be used in various manner and doses; and they are fairly safe. These include:
• Clomiphene: this triggers the release of FSH and LH, which boost egg growth, and monthly release of an egg from the ovaries. It is inexpensive, and woman with polycystic ovaries and irregular periods benefit more from this drug.
About 60% of the women on this drug ovulate, and 30% become pregnant within the first 3months. There are a far side effect which includes nausea, insomnia, tenderness of the breast and headaches.
• Bromocriptine: this suppresses the lactating hormone, Prolactin. When this is released in excessive amounts, stops ovulation. 90% of women on this drug release eggs. It is fairly safe, and the side effects include nausea, dizziness, headaches and low blood pressure.
• Human Menopausal Gonadotropins (HMG): this drug is used when the previous two fails. It contains large amounts of FSH and LH. This drug is effective with woman who fail to ovulate, endometriosis, cervical problems and unexplained infertility. A serial monitoring of the number and size of the eggs being produced is carried out by ultrasound monitoring.
* 70% of women release eggs while on HMG medication
* The chances of pregnancy varies from 20 – 80%
* They are moderately priced, and may carry risks such as spontaneous abortion, ovarian enlargement, leading to ovarian cysts.
* There is an increased risks of multiple and premature births, and the patient may notice weight gain and abnormal swelling.
It is important to know that in many cases, medications are indicated while in other cases surgery or other form of treatment may be required. If medications are not useful, and surgeries not appropriate, other specialized techniques are offered.
Medications to solve hormonal problems and ease infections in woman may be offered and lastly surgery to repair reproductive organs may restore the woman’s fertility.
Luteinizing hormone releasing hormones
These (LH – RH) drugs are used when the pituitary or hypothalamus gland is not producing hormones; and for treating endometriosis. This is a hormone replacement therapy.
Human chorionic gonadotrophins (hcg):
HCG are normally prescribed with HMGS, Clomiphene citrate to stimulate the release of egg. They are also used to treat endometriosis. Clinical trials have shown that Humegon, a type of HCG has resulted in 26% of pregnancies. Side effects include multiple births, ovarian cyst and enlargement.
Urofollitropin (Fsh) :
This is used also with HCG to bring about the release of an egg, and effective for women with polycystic ovaries syndrome; who did not respond to Clomiphene.
Antibiotics
They cure infections of the reproductive system like the cervix, lining of the uterus and sexually transmitted diseases.
Progesterone hormone:
This hormone helps with the development of the lining of the uterus to aid the fertilized egg to implant.
Corticosteroids
These are steroids and may help with the treatment of endometriosis.Oral Contraceptive, Anti Androgens and drugs which reduce insulin levels:
These drugs are used in women with polycystic ovaries syndrome to restore regular periods and ovulation, and to reduce symptoms as a result of an oversupply of male hormones.
Also drugs to treat thyroid disease, benign tumors and to improve the quality of cervical mucus.
Other surgeries to treat female infertility
These may be necessary if an investigation suggests that surgery is required to cure infertility; and depending on the cause, these may include surgeries to
* Remove fibroids : Myomectomies, and laparoscopic Myomectomies or defects in the woman’s uterus.
* Endometriosis : surgery can be performed, that would remove the uterine scar tissue which has grown exterior to the uterus.
* Tubal repair : To remove a scarred fallopian tube – the scar tissue or scarred part of the tube can be cut off, and the repaired and reattached to the uterus.
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