Infertility Management Sushma Deshmukh
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1Introduction
  • Doctor We Want a Child
    Sushma Deshmukh
  • Initial Work-up and Diagnosis
    Sushma Deshmukh
Sushma Deshmukh
2

Doctor We Want a Childchapter 1

Sushma Deshmukh
Infertility is a global issue for an issue. Couples from all levels of society come to clinician. The only statement from them is ‘Doctor do anything but we want a child!’
Human reproduction is a complex system. If we look at the system carefully then we also give credits to Almighty God or nature that though it is complex, every system is hormoneously organized. All hormones are in tune and rhythm. Endocrinal, reproductive and body's defensive systems working synergistically.
Incidence of infertility is about 15 percent in the population. We call a couple infertile when there is no pregnancy after 1 year of marriage without using contraceptive with regular sexual practice. So it is very important that the couple should be aware of it. In infertility, mind and psyche involved along with body. And in many communities it is social taboo. The couple always keeps on telling you that ‘Doctor do whatever but we want affirmative results, i.e. child’.
Infertile couple is always in stress and strain. Many of the couples are wandering from one doctor to another. Some of them are lucky enough to get a proper treatment. But infertility is such a problem that many faculties with little knowledge treat it. And when all efforts are in vain then the couple come to an infertility specialist.
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Most of the patients when come to us they have pile of files with them. It is very difficult to go through all files when clinician is busy in the outpatient department (OPD) where a large crowd is in the waiting room. But one should make a habit that just to have a look at the files and try to go through it in a short span. Note down the important points in your own file. While going through the files if for a moment you look at them, then you will notice that most of the couples have very high hopes on their faces, i.e. for child. Some are desperate. Some will say that we have no hopes but someone has recommended your name. So as a last try we have approached to you. And your tension and responsibility goes on increasing.
In other branches of our obstetric and gynecology, we have very bright options in treating patients, e.g. antenatal care (ANC) patients, gynecological problems like prolapse uterus, DUB, fibroid. But treating infertility is many times frustrating for the clinicians as well as patients. Because they demand a new live creation either naturally or artificially, i.e. child.
So when a infertile couple comes to your center, since beginning, i.e. from reception, they have to be treated nicely. It is an usual complaint of the patient that they have been sitting in the waiting hall since hours. In a busy infertility clinic it is not possible for the clinician to do a perfect time management. But at least use kind words, give them adequate time and always explain the plan of treatment.
Many newly married couples rush to infertility center for treatment within 3–6 months. Counsel them that only 15 percent conceive in 1st month. Fifty percent in 6 months. 75 percent in 1 year and 90 percent at the end of 2 years.
Always insist the couple to come together and examine husband and wife by andrologist and gynecologist respectively. After that counsel them together and explain regarding the female reproductive system; particularly ovulation and importance of tubal, uterine factors.5
 
Divide the Patients in Four Categories
  1. Young couple married recently but anxious about baby or young couple married just one year back but not having knowledge regarding fertile period.
    In such couples we can do basic investigations like semen analysis, transvaginal sonography and counseling. If report comes normal we can wait for 2–3 months.
  2. Couple married more than 2 years, age around 30 years. Particularly female with mild male factor. In such patients routine investigations, hormonal evaluation, ovulation study, investigation for tubal factors are required. If any problem diagnosed then try to treat it accordingly. Such couples require regular follow-up.
  3. Any age group but less than 35 years with previously diagnosed conditions like tubal block, endometriosis, severe male factors. Such females require laparoscopy/hysteroscopy operative treatment, IUI. Such couples require exhaustive plan of treatment. They require IVF also.
  4. Old age couples, young females with premature ovarian failure or severe uterine problems. All such patients require IVF back up only, with ova/embryo donation/surrogacy.
Broadly we can divide the couples in such categories. But every patient is different and present in any combinations.
A 33 years female and husband 34 years, married 12 years back came to me for consultation. They have already undergone 6 IUI in other infertility clinics. Both are highly educated. Husband was having his own business and wife was involved with that business only. Both used to travel India and out of India together always. When we examined them, husband admitted that they were staying together but they have had not routine contact. Then with proper counseling husband was kept on trial. After 2 months he was able to perform. Then 3 months after that wife became pregnant.
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All cases are not alike but it shows that thorough examination and proper counseling has got a important role in infertility. One more important thing is couple is always anxious about the expenditure. As such infertility treatment is costly, as well as lengthy. But try to minimize investigations by thorough clinical exam and history.