COUPLE Reproduction is a complex process. Fertility is the normal physiological function of the body like any other function. Most of the people who can not conceive are not suffering from any disease or ill health. It is important that all the events of fertility factors are evaluated for their efficiency and normalcy. The known means help to evaluate the male and ovarian factors and reproductive passages, but have no access to the events beyond.
The past practice of investigation of infertile couple has been semen analysis and tubal patency tests mostly by hysterosalpingography. Ovarian function was tested by premenstrual biopsy and later by progesterone levels in luteal phase of the cycle. If the results are favorable the couple was told all is well and there is nothing wrong. It is oversimplification of a complex process. It only indicates that the ovum and sperms have the chance of coming in contact with each other. There is no insight of the problem and the information of possibilities of fertilization or implantation is lacking. It is still followed by many. The conventional semen analysis does not predict the fertilizing ability of the sperms. Premenstrual biopsy and hormone assays reflect hormonal status showing that the luteinization may have taken place and not the ovulation which is shedding of ovum from its shell. Hysterosalpingography only shows that the reproductive passages may be open or blocked but does not reflect the functional accuracy of the organs.
The modern approach is to evaluate the events in the various fertility factors and manage if there is any deficiency. The techniques used are ultrasonography, hormones assays, cervical mucus studies vis a vis cervical mucus interaction tests, semen analysis, gynecological endoscopies and X-Rays. Non invasive techniques are preferred. Invasive methods used only when necessary.
Clinical Assessment The couple is listened to carefully giving a patience hearing. Their requirement is judged the way they see to it and then plan examinations and investigations to approach its cause or causes. Investigative procedures whose result is expected to resolve the problem or modify the treatment being given are done. Results of appropriate investigations and managements already done are accepted and not repeated and forward look approach is adopted.
First Visit: The circumstances of the couple are recorded so that a plan is drawn for the management of individual couple. Each one is given an identification number.
Background: Age, Marital and social circumstances. It is important for the informed consent that the views are received and described in understandable manner. Couple’s education, social status and environmental circumstances help. Age, professional status & the nature of employment can influence fertility. Woman’s age has most important bearing on the outcome of any treatment for fertility.
Sociosexual relationships are important. Notice is taken of the circumstantial separation of the partners from each other; husband often away from home due to employment or working abroad.
Menstrual, Fertility and Obstetric history: Menstruation is clinical manifestation of the ovarian and uterine functions. Infrequent periods reflect infrequent ovulations and preclude fertility problems. Late onset of periods (Menarche) reflects slow fertility so are pregnancies with long intervals. Menarche is the age of onset of menstruation. The cycle is from the first day of the period to the first day of the next. This is in fact the ovarian cycle. Ovulation precedes menstruation. Duration and amount of blood flow is enquired.