ASK DR. BAUGHAN                                                                     April 4, 1997

INFERTILITY EVALUATIONS

“Could you please write about what is involved in an infertility evaluation?”

One of the most difficult aspects of diagnosing and treating infertility problems is remembering that conceiving, bearing, birthing and raising children is about love.  Two people decide that they love each other enough to create a new life, a life which they can nurture with love.  When that desire for a child runs into a roadblock of infertility, it is easy to lose site of that key instigating energy, the love of a couple.  Infertility evaluations should begin with the couple approaching the challenge as a couple.  At several steps along the way, it is very easy for one person to be labeled “the problem,” feel defective, or the desired baby to become an object or product that proves something about one or the other persons in the couple.

With that stated, what are the first physical considerations?  Simply enough, does intercourse occur when conception is likely to occur?  If a woman ovulates, there is a 3-4 day “window of opportunity” each month when conception can occur.  Is the couple healthy, rested, and able to create a situation when love-making can flourish in the optimal time of the menstrual cycle?  “Honey, the time is now!” creates all sorts of performance anxieties in most couples, and often puts a strain on the love.  Many a couple have achieved pregnancy when they stopped trying so hard and decided to enjoy each other.

The male evaluation assesses general health for chronic conditions that may decrease sex drive or sperm production.  Lifestyle factors, such as cigarette  smoking or alcohol excess, may affect either.  Anything that elevates the temperature of the scrotum, including tight shorts or pants, may decrease sperm production.  An anatomic variation called a varicocele (a collection of veins in the scrotum) increases the temperature by increasing the blood flow;  this can be corrected surgically.  Timing the frequency of intercourse can maximize sperm counts.

The female evaluation also begins with a general health survey for conditions such as anemia or hypothyroidism or other chronic diseases.  Next, does the woman ovulate?  Checking the basal body temperature carefully each morning can usually establish this; expensive hormonal blood tests are not always necessary.  If the woman ovulates, is there any inflammation of the cervix, abnormality of the uterus, or blockage of the fallopian tubes.  Much information can be obtained from a history, a Pap smear, and a pelvic exam.  There are several tests to check out the health of the uterus and tubes, including tiny scopes, ultrasounds or xrays.  Sometimes there is an interaction between the woman’s mucus and the semen that can be detected and treated.

There is something odd about a country where much money and research will be spent on dramatic treatments such as in-vitro (in a test tube) fertilization when 1/4 to 1/3 of all births occur out of wedlock.  Much infertility could be avoided by stopping the widespread problem of sexually-transmitted diseases.  We have some wonderful, seemingly miraculous, treatments for infertility.  The greatest miracle would be if we could conceive and raise all our children in love.