Diagnosis of an infertility problem will usually begin with physical examinations and complete medical and sexual histories of both partners.
A fresh sample of the man's semen will be examined under a microscope to determine the quantity and quality of the sperm. The results of the exam will provide a sperm count and will also indicate whether the sperm are adequately mobile and whether the heads of the sperm are oval, both characteristics that are necessary for conception.
To determine whether ovulation is taking place in the woman, the basal body temperature (the body temperature on awakening, before eating or drinking) will be taken every morning for several months. If the temperature rises by 0.6 degrees Fahrenheit to 1.0 degrees Fahrenheit for a few days in the middle of the menstrual cycle, ovulation is probably taking place. An endometrial biopsy, in which a sample of the lining of the uterus is obtained for examination, can also indicate whether ovulation is occurring and whether hormonal secretion is normal.
Obstruction of the fallopian tubes can be diagnosed by injecting a dye into the reproductive tract and then taking an X-ray examination. Another test consists of injecting carbon dioxide gas into the fallopian tubes and waiting for the patient to feel pain in the upper part of the body, indicating that the gas is passing through the fallopian tubes and that there are no obstructions.
A cervix that creates an environment that prevents sperm from surviving can be identified by a microscopic examination of the mucus in the cervix. (The exam is performed shortly after sexual intercourse to determine the rate of sperm survival.) Endometriosis is diagnosed by inserting into the abdomen a laparoscope (a small, lighted instrument), through which the doctor can actually see the uterus, fallopian tubes, ovaries, and any displaced endometrial tissue that may be causing the infertility.
Hormonal imbalances in both men and women can be diagnosed with blood tests.
Treatment for a low sperm count caused by a testosterone deficiency is usually hormone therapy to increase the man's testosterone levels. If the low sperm count is due to chemicals, radiation, or excess heat, exposure to these factors must be corrected or avoided. If the sperm count is low for some unknown reason, there is often little more that can be done to increase it.
Pregnancy is still possible, however. The techniques used involve artificially fertilizing an egg from the woman with sperm from the partner or from another man. The fertilization can take place inside the woman's body or outside the body, in which case the fertilized egg is then transferred into the woman's uterus.
If male infertility is caused by varicose veins, surgery may be necessary to fix the problem. If an obstruction exists somewhere in the tubes leading to and through the man's penis, microsurgery to open the blockage may be used to correct the problem.
Failure to ovulate is often treated with a fertility drug called clomiphene, which stimulates production of the hormone that regulates ovulation. About 60 percent of the patients who receive clomiphene become pregnant; the chances of multiple births are very low. A stronger drug, which is a combination of certain pituitary gland hormones, may also be prescribed, but it carries with it a greater likelihood of multiple births.
Obstructed fallopian tubes may require microsurgery to open the blockage or a procedure in which an egg is removed and replaced beyond the point of the obstruction, where it may be fertilized normally. A cervix that prevents the survival of sperm can be treated with the female hormone estrogen, which stimulates the increased production of mucus that is necessary to transport the sperm. Sometimes sperm can be placed directly into the uterus, bypassing the cervix completely. Endometriosis can be treated by the surgical removal of displaced tissue and the scar tissue that has formed around it. Hormonal imbalances can be corrected with hormone therapy.
Test-tube, or in vitro, fertilization is a technique in which an egg is removed from the woman's ovary and then placed in a test tube or special sterile dish containing the man's sperm. Once the egg has been fertilized, it is placed into the woman's uterus, where it will continue to grow. This technique is used primarily in women whose blocked fallopian tubes cannot be opened by surgery.
Another new technique used to treat infertility is called gamete intrafallopian transfer (GIFT). In this procedure, clomiphene or another fertility drug is given to the woman to stimulate ovulation. When an egg is produced by the ovary, it is removed via laparoscopy and immediately mixed with sperm from the man. This sperm-egg mixture is then transferred by laparoscopy into a fallopian tube, where fertilization may then take place normally. Fertilization occurs in the woman's body and not in a test tube. GIFT is a complicated and expensive procedure that should be used only by couples who have not been able to conceive using standard treatments for infertility.
Although recent advances in treating infertility have led to greater and greater success, about 15 percent of all female infertility problems and about 10 percent of all male problems remain undiagnosed and therefore untreatable.
Now let's consider another, very common, treatment for infertility: artificial insemination.
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