Many infertile patients get very
frustrated by the barrage of medical tests which they are mindlessly
subjected to when they visit their doctor for medical assistance.
This is why we have developed a "Fast-Track"
Infertility Diagnostic Workup, which allows us to tell our patients what
their medical problems are, in less than 15 days ! They just need to
make 3 visits to the clinic, thus saving a lot of time, money and
energy.
In order to determine why pregnancy doesn't occur ,
we need to examine only the four critical areas which are needed to make
a baby - eggs, sperm, fallopian tubes, and the uterus.
Traditionally, before starting with tests, the
doctor takes a detailed medical history from the couple, and also
performs a physical examination for both of them, to determine if this
can provide clues as to the cause of the problem. The doctor will need
to find out details about your menstrual cycle, as well as your sexual
habits and past history of surgery or illness, so you should be prepared
to answer these questions. Many clinics give patients a form to fill
out, so that they can provide all this information. A physical
examination can also provide the doctor with useful information, and he
will look specifically for important clinical findings such as abnormal
hair growth, excessively oily skin, or the presence of a milky discharge
from the breast. In real life, however, we have found that the utility
of the history and examination is actually very limited; and that for
most couples, investigations are needed to establish a diagnosis. These
specialized tests constitute the infertility workup and they can be
completed efficiently in 15 days . Timing the procedures properly during
the menstrual cycle is important and we have found the following
strategy useful in our practice.
The couple must be seen together and the first test
which should be done is a semen analysis. Sadly, sometimes the wife will
have undergone innumerable tests (sometimes repeatedly !) and the
husband's semen analysis (where the problem lies) has not been done even
once.
The first day the bleeding starts is called Day 1,
and the semen analysis to check the husband's sperm count and motility
can be done can be done on Day 3-4 , after requesting him to abstain
from ejaculation for at least 3 days . The wife's blood is tested at
this time for measuring the levels of her four key reproductive
hormones: prolactin, LH ( luteining hormone) , FSH ( follicle
stimulating hormone) , TSH ( thyroid stimulating hormone). Since these
levels vary during the menstrual cycle, they should be done between Day
3-5 of the cycle. We then do a hysterosalpingogram (an X-ray of the
uterus and tubes) for her after the menstrual bleeding has stopped -
between Day 5-7, to confirm her uterus and tubes are normal. We then see
the couple on Day 11 , with the results of all these reports . We
also do a vaginal ultrasound scan at this time, to confirm that the
uterus and ovaries are normal, and review the results of all the tests.
These four basic tests allow us to check whether the eggs, sperm, uterus
and tubes are normal.
Day 3 - semen analysis for husband; blood tests for
wife for FSH,LH,PRL and TSH
Day 7 - HSG for wife
Day 11 - vaginal ultrasound scan for wife; review of
reports and formulation of treatment plan
Our fast-track infertility diagnostic workup
allows us to get to the heart of the problem, without wasting time and
money. The total cost of the entire workup in our clinic is only Rs 5000
( approx US $ 100 !). The consultation costs Rs 500; blood tests cost
about Rs 1200; the semen analysis is Rs 200; the HSG is Rs 1500; and the
ultrasound scan is about Rs 500.
Some doctors will perform further testing during the
rest of the month, though we rarely do these tests in our own practise .
They include: ultrasound scans for ovulation monitoring between Day
11-16 ; and the scan results can be used for timing the PCT (postcoital
test) as well, during which time the cervical mucus is assessed also. A
serum progesterone level can be measured on Day 21, about 7 days after
ovulation , and this provides information about the quality of
ovulation. Some doctors will also performed a laparoscopy in the same
month (Day 20-25) ; and combine it with an endometrial biopsy , if
desired.
With our strategy, time is not wasted, and couples
can be reassured that a possible reason for the cause of the infertility
, if it exists, will be detected within one month.
Unfortunately, it is very common to find that tests
are done piecemeal - or sometimes, not done at all. Often treatment is
started before coming to a diagnosis. Conversely, some doctors take so
long to do the tests, that patients get fed up - after all, they want
treatment!
A single test abnormality does not necessarily mean
that a problem exists and the test may need to be repeated, to confirm
that it is a persistent problem.
Sometimes it can be difficult for patients to come
to terms with the fact that there is a major problem which presents a
significant hurdle to getting pregnant. The truth can be bitter , but
it’s far better to face up to it and deal with it, rather than live in a
fool’s paradise ! With today’s advanced reproductive technology, we can
always find a solution, no matter what the problem – but remember that
unless you can intelligently identify the problem, you cannot find a
solution !
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