When to seek advice If there is too much anxiety the couple can seek advice anytime for explanation and understanding. Premature extensive investigations can increase anxiety. As amply emphasized the couple is normal seeking advice and assistance and should not be considered sick seeking treatment. Evaluations and management depends on the need of individual couple.
General principles are that the young couple should not worry for 12 to 18 months of marriage. If they seek advice early they are patiently listened, their circumstances evaluated, fertility factors explained and assured to enjoy the joys of married life. In the following circumstances earlier consultation is advisable;
- The couples who marry late, especially women after the age of 35 may seek advice early (3-6 months after marriage).
- The couple with family history of low fertility and surgery of reproductive organs, women with menstrual irregularities and men with the history of mumps may consult early.
The availability of ART has changed the strategy of management of infertile couples. The modern trend is that a fertility specialist when investigating looks towards the outcome of his efforts (prognosis) as his priority rather than diagnosis. After first assessment the sequence of plan is in consideration to:
- Does the couple understand their fertility? Can the wife conceive without any treatment just after understanding the requirements of fertility? They may not know the fertile period of the wife and not used the right time for coitus.
- The modern approach is to consider if the couple need IVF or any other ART technique? If IVF is the choice, there is no need to undergo so many cumbersome investigations. The ovulation has to be induced in all cases. The availability of the sperm is the only requirement.
- Is there possibility of defects in the reproductive passages? If NOT the evaluation of reproductive passages can be deferred. If so their evaluation should be the priority because in case of blocked tubes only choice is going to be IVF.
- How are the sperms? Can they fertilize the ovum in vivo? If not IVF/ICSI is the only choice and plan goes to the question No. 1.
After the initial evaluation schedules are drawn for the Individual couple. The visits are designed to evaluate the fertility status of the couple with least inconvenience.
Young couples with short duration of marriage Depending on circumstances, especially in young couple with short duration of marriage two convenient reassuring plans have been designed. It is kept in mind that they need to build their confidence and relieve the anxiety.
Plan-I An appropriately designed chart to record Basal Body Temperature (BBT) and coital tendencies along with some other features is given to be filled. It is done for 3 cycles. This simple format gives quite useful information.
Plan-II for individuals where organic lesion is not found or suspected on clinical evaluations. It evaluates the wife at the preovulatory or ovulation phase after the sexual intercourse during the night.
- Cervical mucus is observed whether fertile type or not;
- Post coital test done and grade 4 motile sperms counted per high power field of microscope;
- TVS to see the Leading follicle with FD >16 mm and Triple Line Endometrium > 6 mm thick.
These observations are repeated in 3 consecutive cycles. If results are favorable, the fertility status of the couple is satisfactory. It is likely that wife will be pregnant spontaneously in due course.