WOMEN’S BODIES: TREATMENTS OF SUBFERTILITY – I.
If something can be done to treat any cause found, the treatment and reason for it will be explained to you so that you can decide whether you want to go ahead. Such treatments include measures to improve the sperm count or reduce sperm antibodies, drug therapy to stimulate ovulation and procedures to correct blocked tubes.
Improving sperm count First, reducing excessive smoking and drinking is advised; any general health problems are given attention and if drugs or occupational factors are suspected, these should be eliminated if possible. If there is a problem with the hormones that control sperm production (rare), in many cases this can be corrected. Surgery may be attempted to open up any block in the tubes that carry the sperm into the semen, though the success rate of these procedures is low. A varicocele can be removed surgically; this results in increased sperm production in some but not all cases.
Reducing sperm antibodies To suppress the immune system and formation of antibodies, medication with cord steroids may be offered.
Stimulating ovulation If you’re not ovulating, you’ll be advised to have further tests to find out exactly how the hormonal control of ovulation is disturbed. Until quite recently there wasn’t much hope for women who didn’t ovulate. Today the so-called ‘fertility drugs’ will produce ovulation in almost all women who use them. These drugs include clomiphene, gonadotrophins, bromocriptine and gonadotrophin-releasing hormone (Gn RH). Clomiphene and GnRH stimulate the pituitary gland to produce more FSH and LH. Gonadotrophins are tried when pituitary can’t be made to produce its own. Bromocriptine is used when ovulation stops because there is too much prolactin in the circulation.
The use of drugs that stimulate ovulation is very complicated; they are usually prescribed and monitored by fertility specialists in centres with close access special laboratories, as regular (sometimes daily) blood tests must be done on the patient to check progress and work out the next dose. You should have explain to you what this treatment entails, such as the frequency of specialist visits required, chances of success, the possible side-effects, the risk of multiple pregnancy and the cost. Ask about these things.
If you’re very underweight, you may encouraged to eat up and gain some weight before starting the treatment stimulate ovulation. On the other hand, if you’re very overweight you may need to lose some.
Surgery for blocked tubes What can be done depends on the cause and extent of the blockage. This is delicate, painstaking surgery (called tuboplasty) and as the canal through the tube is only 1 mm or so wide in some parts, microsurgery techniques are used.
Even if the tube can be opened, fertility can’t be guaranteed. Scar tissue may form after surgery and re-block the tube. The tubal lining, which has an important role in the safe passage of the fertilised egg through the tube, may have been damaged by whatever caused the blockage in the first place. No matter how skilful the surgeon, it may be impossible to restore the function of a badly damaged tube.
Your surgeon, after looking at the outside of your tubes through the laparoscope and maybe inside by falloposcopy, will give you a realistic opinion about whether it’s worth trying to repair the canal through your tubes and the chance of pregnancy afterwards.
*191/31/5*
