Infertility in our country is more of a social problem than a medical disease. 90% of the infertile couple can confidently hope for a child, thanks to the newer modalities of treatment. For the optimal success of treatment, proper selection of couple and treatment programme, monitored by experienced doctors are necessary.

What is infertility?

When a couple fails to achieve conception with in one year of unprotected intercourse it is termed primary infertility.

Secondary infertility is the situation when conception ends up in abortion, recurrently at varying period of gestations or if they fail to conceive after an abortion or delivery. The ovaries are situated on either side of the uterus in the lower abdomen and produce the ovum, which in turn meet with the sperms in the fallopian tubes, few hours after the intercourse to result in an embryo. The embryo returns to the uterine cavity to grow as the foetus. Infertility results when any one of these steps are affected.

Investigations in Infertility
Let us see how an infertile couple is approached.

First and foremost the detailed history, past medical and surgical treatment history and detailed physical examinations is done for both partners and further tests are planned.

Semen is collected via masturbation and semen count, motility, abnormal morphology and pus cells are estimated and corrrective treatment are given accordingly. Blood tests may be needed depending on the severity of semen parameters. Detailed semen quality anlaysis are now available.

In the female, the investigations are aimed to know whether she is ovulating normally and to see whether any obstruction exists in the genital tract, preventing the access of sperms to the egg. This might need hormone estimation, frequent Ultrasound examination, hysterosalpingogram (X-ray of uterine cavity and fallopian tubes), endometrial biopsy and hysterolaproscopy. Around the time of ovulation the cervical secretions are very thin. The couple is advised to return after a specific time after the intercourse. The test is called postcoital test. This test would give useful information regarding the cervix, its secretion, its interaction with sperms and to see whether they are friendly (cervical hostility). It is also useful to predict timing of ovulation.

A regular menses almost always equates with regular ovulation. Very rarely menses can occur with out ovulation. Irregular menses occurs in patients with improper ovulation, when the normal synchronised action of the brain Hypothalamus pituitary and ovary is lost.

Endometrial study and hormone assay help to find out which stage of this pathway is affected.

While evaluating the female for ovulation, frequent scanning is necessary to evaluate the follicular growth and rupture and also endometrial changes. However the tubal status and uterine cavity anomalies are better studied by HSG (special X-ray for uterus and tubes) or SSG (special ultrasonography in which fluid is instilled into uterus and spill seen at the tubal ends.) Ovulation can be corrected by medical treatment. In severe cases certain surgery to ovary helps.

Role of Hysterolaparoscopy in Infertility

Laparoscopy (Key hole surgery) enables to evaluate the internal organs & Hysteroscopy to see the inside of uterus and cervix. Patients with certain congenital abnormalities also benefit from surgeries. Patients with endometriosis benefit from laparoscopy.

Any tumors or cysts in the uterus and or in the ovary can be detected and removed via laparoscope.

PCOD will lead to abnormal ovulation or even total absence of ovulation, such patients benefit from surgery to some extent.

Endometriotic adhesions and cysts can be removed with the use of laparoscopy.

Hysteroscopy is used to visualize the inside of the uterus in detail and to resect any tumor, polyp, or septum. The opening of tubes into the uterus can be seen, and any tubal block can be corrected by passing a very fine cannula into the tubes.

Couple with unexplained infertility also need hysterolaparoscopy after a reasonable trying time to rule out any of the above mentioned pathology.