TREATMENTS FOR INFERTILITY
Compared with only a few-decades ago, there is now a remarkably wide range of effective treatments for infertility disorders.
REMEDIES FOR A WOMAN
Treatment for disorders of ovulation involves the use of drugs, which can often induce ovulation.
Ovarian problems can be treated by drug therapy, but physical malfunction of the Fallopian tubes cannot. It thus represents a more serious obstacle to pregnancy. Surgery can sometimes be successful in unblocking tubes, but more often it cannot replace the loss through disease, of correct tubal function.
It is in this bleak context that 'test-tube babies', produced by a variety of clinical techniques, have been hailed as a breakthrough in the therapy of infertility. In women with irrevocably blocked tubes, it is now possible with drugs to induce multiple ovulation. The ripe eggs are removed by laparoscopy and fertilized with sperm from the partner 'in vitro'—that is, in a dish (not really in a test tube). The developing embryo is then reinserted into the uterus where implantation can occur.
Recently, an Australian team, and then a British one, succeeded in implanting a fertilized egg, frozen at a very early stage of development, into women who subsequently produced healthy babies.
REMEDIES FOR A MAN
Treatment of male infertility problems often comes in the form of simple practical advice. This may be about the timing of sex during the menstrual cycle or the use of lubricants. Tight underwear can raise the temperature of the testes causing a drop in sperm production. A low sperm count can sometimes be improved by hormone therapy, and for some blockage problems, surgery can be useful.
REMEDIES INVOLVING BOTH PARTNERS
Certain positions (above) allow sperm to be deposited close to the cervix, and, if the woman remains in this position for 20 minutes after intercourse, sperm can reach the uterus quickly. Artificial insemination by husband (AIH) may also be tried. This involves inserting a sample of the husband's semen (and sometimes pooling a number of specimens) beyond the woman's cervix. If this does not work, the last resort is usually artificial insemination by donor (AID). This requires the couple attending a
special clinic at which a doctor inserts a sperm sample from a healthy donor, often mixed with one from the husband so that he may still become the father, into the woman's uterus. This often succeeds in producing a pregnancy.
TESTS AND EXAMINATIONS
A modem infertility clinic has at its disposal a wide range of tests and investigations.
FOR A WOMAN
Investigations range from the homely to the 'high-tech' methodology of the biochemistry laboratory. Ovary activity and ovulation, for instance, can be checked at home by measuring the body temperature on waking each morning. Around the time of ovulation in a normal cycle, there is usually a body temperature increase of about 0.5 "C.
A range of hormonal tests from blood or urine samples can give more detailed information about the control of ovulation and other aspects of the menstrual cycle. The tests are used to examine levels of FSH, LH, oestrogens, plasma progesterone, and urinary pregnanediol. Roughly 20 per cent of infertile women have Fallopian tube abnormalities, and the defects are often the after-effects of tubal disease resulting from pregnancies, abortions, peritonitis, pelvic infections and VD. For such women a number of specific investigations are used. Two are common hysterosalpingography and laparoscopy.
FOR A MAN
Tests involve a few hormonal investigations carried out on blood or urine but mainly involve those carried out on semen specimens. These tests should be able to answer the following questions, which can give the investigating doctor many useful clues concerning diagnosis and treatment:
Are the sperm present in large enough total numbers? Are they present at high enough concentration? Are the sperm alive and sufficiently mobile? Are they properly constructed? Is the fluid in which the sperm are suspended normal?
A further type of sperm-related test is the post-coital test, in which samples are removed from the female partner's reproductive tract after sex to see if healthy, moving sperm are present.