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For couples who are desperate to have a baby, being relaxed over sex might be easier said than done. Fortunately, medical help is at hand.
In-Vitro Fertilisation, or IVF, is probably the most widely known form of assisted conception, but not every couple ends up needing it or is suitable for it. And before IVF is even considered, a couple’s fertility issues first have to be assessed and other treatments explored.
Dr Christopher Chen of the Christopher Chen Centre for Reproductive Medicine describes what typically happens when a couple approaches him for help. “Both husband and wife come for the first consultation. During this time, their clinical history is obtained and an assessment of their fertility states made. Information about their age, the duration of their marriage, the period they have been trying earnestly to conceive, whether they have had previous pregnancies, children, miscarriages or even previous marriage partners is obtained.”
In the next stage of the first consultation, the husband provides a semen sample so that the quality of his sperm can be assessed. It is also tested against his wife’s vaginal mucus to check whether her mucus is toxic to his sperm. Dr Chen continues, “Once the semen report is available and if a problem is detected, the husband is usually examined to determine the cause of his sperm problem, which is most commonly the presence of varicocoeles (enlarged veins in the scrotum).”
And what about the woman? “For the wife, a detailed history is taken of her menstrual cycle, taking into account its regularity, any pain with her menses suggesting the possibility of endometriosis, heavy menstrual flow due to adenomyosis, and the possibility of uterine fibroids as well as hormonal dysfunction,” explains Dr Chen. Her reproductive hormonal profile is assessed in the third week of her cycle; this includes the study of her hormones: FSH stimulates the production of eggs; LH ripens the eggs; prolactin may affect the breasts and, indirectly, ovulation; and oestrogen and progesterone.
“An assessment of her uterus and ovaries is made through transvaginal ultrasound scanning. This will tell us whether uterine fibroids, adenomyosis, ovarian cysts, endometriotic or hormonal cysts are present,” reports Dr Chen. “The next step for the wife could be a small day surgery procedure, where her pelvis is examined through laparoscopy and the cavity of uterus is examined through hysteroscopic procedures.”
Only after such detailed assessment is a course of treatment recommended.
Contrary to popular belief, IVF is not at the top of the list. “If the man has varicocoeles, then laparoscopic varicocoelectomy is done to improve his semen. Drugs such as Andriol and Provironum can also help significantly. If the woman has problems with ovulation, the ovaries can be stimulated using simple medication such as Clomiphene, progressing to FSH and LH injections.
It is only after these options have been exhausted and the couple still has not achieved pregnancy that IVF is then recommended. IVF costs between S$10,000 and S$14,000 per cycle, and “is a very stressful programme for the wife,” Dr Chen points out.
With these options on offer, there is plenty of hope for couples. So anyone trying to have a baby should do as the doctor ordered—don’t worry too much, try to relax, and enjoy the ride.
Photo courtesy of Thinkstock. This article first appeared in NATURA magazine issue No.6. Find NATURA at Eu Yan Sang retail outlets, newsstands and major bookstores in Singapore.