CLINICAL EVALUATION AND FIRST CONSULTATION
When you and your husband come for your first consultation, please bring along your past medical reports and test results which you may have done in a previous clinic. At the consultation, we need to go through your detailed medical, surgical and family history followed by a clinical examination of both of you including a pelvic ultrasound scan for you. Certain essential basic tests will be ordered and they include semen analyses, mid-luteal phase progesterone test for evidence of ovulation, tests for ovarian reserve which means a menses day 2-3 hormone profile, ultrasound antral follicle count and if needed, anti-mullerian hormone assay. In subsequent reviews we may advise a hysterosalpiogogram (an X’ray) to check patency of your fallopian tubes and any pathology in the uterine cavity such as polyps, fibroids, adhesions or congenital abnormalities.
Once we have enough details from the clinical evaluation and the investigation results, we will discuss the various treatment options for you. The latter can be broadly divided into 2 groups. Group 1 includes treatment modalities to correct the underlying cause of the infertility like ovulation disorders, sexual issues, uterine cavity pathology, mild tubal damage amenable to surgery and repair, endometriosis, fibroids and male factors like severe varicocoeles and slight impairment of sperm factors like count and motility. Group 1 treatment options are usually offered to younger women who have time for the corrective treatment measures offered, as it may take sometime for the treatment to work, e.g. the pelvic organs need time to recover after surgery in order to function and do their job of getting pregnant. Group 2 couples include those who have severe sperm factors, badly damaged tubes and severe pelvic adhesions from past infection or endometriosis, idiopathic infertility and those who failed to conceive despite corrective measures done and also for the older women whose ovarian reserve may soon be exhausted. This group of couples will be offered the In-Vitro Fertilisation/Intra-cytoplasmic Sperm Injection or the Super-ovulation Intrauterine insemination programmes, which ever is indicated and appropriate.
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