INITIAL CONSULTATION
Many factors can cause a
couple to be infertile or subfertile. No
two infertile couples are alike, because each partner
has his and her own individual history.
We always consider the couple
as our patient, not just the wife. Very often – 40% of cases – the
causes of infertility come from both partners.
Therefore, at your first
consultation, I meet
with both partners to review your individual histories.
For this reason, I urge all patients who intend
to see us to
print out a copy of our questionnaire
for husband and wife, fill it out diligently,
and
bring it with you at your first consultation.
You will note that we ask
detailed questions about your family medical history,
your personal medical and surgical history (including
gynecologic for the wife,
and urologic for the
husband), your cycle
history, your previous pregnancies and any obstetric
history, what methods you have used for birth
control, if any; and any previous fertility-related
testing or procedures you may have undergone.
All this provides me with a valuable tool to understand
your fertility problems in a general context, and
helps identify you as specific couple.
After reviewing your history, a sonogram is done
which gives me an initial impression of the condition
of your uterus and ovaries.
This initial screening sonogram
gives vital information about the size of your
uterus, the appearance of its lining 9an appropriate
thickness is desirable to
host a pregnancy), and
whether it has fibroids. It shows the location
and size of your ovaries, the number and size of
visible follicles (egg-bearing sacs), and
whether it has cysts .
The location of the ovaries
is important to see whether both ovaries would
be accessible for aspiration in case IVF is the
eventual treatment, or whether it could be factor
itself for infertility. Here’s
why:
A prior history of pelvic inflammatory disease or
previous pelvic surgery often results in the development
of fibrous scar tissue which binds some pelvic
structures
together and can alsop result in blocking the entrance
to the
fallopian tubes.
Scar tissue can hiold back
or bind down one or both ovaries behind the uterus
instead of the normal anatomic location on each side
of the uterus. Therefore, a patient may have difficulty
conceiving simply because the ovary is in a position
where the ovulated egg is not accessible to the fallopian
tube. And
in case, you
will be undergoing IVF eventually, one
or both ovaries behind the uterus would
be inaccessible
for transvaginal aspiration.
Therefore, when a screening sonogram shows me this
problem, I generally advise laparoscopy (pelvic surgery
that does not involve a major incision and allows
you
to leave the hospital within a few hours after
surgery), either with your own gynecologist, or with
gynecologic surgeons that I have worked with for
years.
Such surgery may also deal with any ovarian cysts
or uterine fibroids detected at the screening sonogram.
Besides our office ultrasound, I generally recommend
that each patient also get a baseline pelvic ultrasound
by a radiologist, along with other preliminary radiologic
procedures that may be necessary, particularly:
- A hysterosalpingogram
(HSG), an X-ray examination
of the uterus and
tubes, to identify and measure
any fibroids present, and determine whether the
tubes are open or not.
- A sonohysterogram (SHG), in which saline
solution is infused into the uterus before taking
an ultrasound which will show the interior of the
uterus in detail, indicating the quality
of the lining and whether it has polyps (fleshy
protrusions of the lining) or fibroids within the
cavity that may interfere with embryo implanatation.
- Mammogram, if the patient is 40 or older.
- Scrotal ultrasound, for selected
male patients if their history indicates a
need
for it.
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