Finding an infertility specialist

There are several types of specialist that you may see for an infertility problem:

1 Andrologists are specialists in matters relating to the male reproductive organs.

1 Gynaecologists specialise in matters relating to the female reproductive organs.

1 Infertility specialists are gynaecologists who specialise in the treatment of infertility. If such a specialist practises in the area where you live, ask your family doctor for a referral straight to the top!

If you live in an urban area, you may have several infertility specialists to choose from. Rather than your family doctor simply referring you to one particular specialist, you may want to think about what's important to you and ask to be referred to the specialist who best fits your preferences in terms of the following issues:

1 Distance to travel: You're likely to need to see the infertility specialist a number of times, so not travelling too far may be an important consideration.

1 Doctor's gender: Do you prefer a female doctor or a male doctor?

1 IVF expertise: Not all gynaecologists perform IVF, so if you think you may need IVF ask about this before choosing a specialist.

1 IVF treatment location: Infertility specialists sometimes practise in different locations, but they perform IVF at one particular clinic. Knowing which clinic a specialist uses may help you to make your choice.

1 Recommendation: If you know someone who's had infertility treatment, it may be worth asking that person to recommend a specialist.

1 Waiting time: Some specialists have long waiting lists for new patients — if you have to wait months for an initial appointment, you may consider seeing someone else.

If you live in a rural area or small town, you may not have access to an infertility specialist, but any gynaecologist who practises nearby can undertake your infertility investigation.

Busting the myth that stress causes infertility

Well-meaning (or maybe not so well-meaning) friends and relatives may suggest that you can't fall pregnant because the female partner (it's always the female partner) is too stressed or too focused on her career. It sounds tempting to think that stress may be the reason for your inability to conceive and some women take this message on board.

The theory that being too stressed can stop you from getting pregnant has been the subject of much research and to my knowledge there's no good evidence to support this theory. In fact, it's very unhelpful to suggest to someone that stress causes infertility because — guess what — if you're infertile and believe that it's because you're too stressed, this makes you feel even more stressed! However, plenty of research shows that infertility itself is a very stressful experience. How stressful depends on the individual, but an unfulfilled wish for a child is inevitably distressing.

So don't get caught up in the idea that you somehow cause yourself to be infertile just because you're too stressed, work too much or want a career. Disregard 'friendly' advice to take a holiday, cut your hours at work or avoid going for a promotion: Such action isn't going to increase your chances of having a baby, and it may cause you to miss out on career opportunities.

You must be happy with how you and your infertility specialist get along because you're at the mercy of this doctor throughout your infertility investigation and treatment. Bedside manners matter, so if you're not comfortable with a specialist, consider looking for someone who better fits your needs.

Having the infertility investigation

After you've found a suitable infertility specialist, the specialist has to determine the cause of your infertility in order to decide what type of treatment you may need. Many different types of tests and investigations are available and you start with the simplest and least invasive, moving onto the more-complex tests until a cause is pinpointed.

The infertility investigation often takes quite some time and effort, and you can easily find yourself getting a bit impatient because all you want to do is to get treated. Try to keep your cool because getting the right diagnosis prevents you from going down the wrong treatment track — saving you valuable time and money.

Testing him

The main test for the male partner is usually a sperm test or semen analysis, which is analysed in a specialist laboratory. You receive detailed instructions about ejaculating into a special jar (very clinical) at home and where to deliver the sample. The World Health Organization (WHO) standards for what's considered normal in a sperm sample are accepted by most infertility clinics. The lab report details several things about the sperm, including the following:

^ Antisperm antibodies: These can cause clumping of sperm, rendering them unable to move and fertilise the egg. A normal sperm sample has no sperm antibodies.

^ Concentration: The number of sperm per millilitre of ejaculate. WHO standard: more than 20 million per millilitre.

^ Count: The total number of sperm in the ejaculate. WHO standard: 40 million or more.

^ Morphology: The percentage of sperm that have normal shape. WHO standard: more than 15 per cent.

^ Motility: The percentage of sperm that move forward vigorously. WHO standard: 50 per cent or more.

^ pH: Should be alkaline.

^ Volume: The amount of ejaculate expressed in millilitres. WHO standard: 2-5 millilitres.

^ White blood cell count: There should be very few white blood cells; a lot of white blood cells can be a sign of an infection.

Each component of the report reveals something about your fertility but the components need to be considered together to make sense. From the analysis the specialist can tell you whether the quality of your sperm may be a reason why you haven't conceived. If your sperm test is normal, you probably won't be tested further. However, if your sperm test reveals severe abnormalities, the specialist may ask you to undergo a testicular biopsy, during which tiny pieces of testicular tissue are taken via a needle and examined under the microscope to see whether you're producing sperm. Depending on the outcome of the biopsy, you may need a blood test to check your hormone levels and to get a final diagnosis regarding your sperm.

Tongue twisters

The terms that are used to describe different sperm problems deserve a mention, because they sound like extremely weird creatures indeed!

I Asthenospermia: Not enough sperm swimming forward

I Azoospermia: No sperm

I Oligospermia: Fewer sperm than normal

I Teratospermia: Too many sperm with abnormal shape

If you have several sperm problems, these weird words are put together to create even stranger words!

I Asthenoteratospermia: Not enough sperm swimming forward and too many with abnormal shape

I Oligoasthenoteratospermia: Too few sperm, too many with abnormal shape and not enough swimming forward

I Oligoteratospermia: Too few sperm and too many with abnormal shape

Testing her

The female partner may need to undergo several tests and procedures. These tests check whether you have an ovulatory problem and whether your ovaries (where the eggs are stored), fallopian tubes (which transport the eggs to the uterus) and uterus are normal.

I Checking ovulation: A common reason why couples have trouble conceiving is that the woman rarely or never ovulates. During ovulation, the woman's body releases a mature egg that if fertilised by a sperm grows into a baby. Two hormones regulate ovulation and the menstrual cycle:

• Follicle-stimulating hormone (FSH)

• Luteinising hormone (LH)

These hormones are produced by a small gland in the brain called the pituitary gland and they interact with two other hormones, oestrogen and progesterone, which are produced by the ovaries.

To check whether you ovulate, you may have blood tests to measure these hormones and most likely also a vaginal ultrasound examination, where your ovaries can be seen on a screen.

Around ovulation time your body temperature increases slightly. In the 'bad old days', a woman with a suspected infertility problem would be asked to take her temperature every morning before getting out of bed, sometimes for months on end. The doctor used these measurements to work out if and when the woman was ovulating. Don't get talked into following this procedure — blood tests and ultrasound are much more reliable (and far less time-consuming) ways of verifying ovulation.

1 Looking at your fallopian tubes: If ovulation isn't the problem, the next test examines whether your fallopian tubes are healthy. A vaginal ultrasound examination gives some information about the fallopian tubes but a laparoscopy is more exact. A laparoscopy is an internal abdominal examination, for which you're given a general anaesthetic. The doctor makes a small incision close to your navel through which an instrument is inserted so that the doctor can thoroughly examine the organs in your pelvis, including your fallopian tubes and uterus. This examination may reveal that the reason you don't conceive is due to a tubal problem (I discuss this issue in the section 'Female causes' later in the chapter), but may also show that everything looks just the way it should.

1 Peeking into your uterus: To make sure that the uterine cavity — the inside of the uterus — has all that it takes to provide a 'good home' for a pregnancy, you may undergo one or both of the following tests:

1 Hysterosalpingogram (HSG): Contrast (which works like a dye) is injected into your uterus via the cervix (the neck of the womb). Your uterus and fallopian tubes are then X-rayed in order to check the outline of the uterine cavity and whether fluid flows freely from your uterus through the fallopian tubes.

1 Hysteroscopy: A thin telescope-like instrument is inserted into your uterus through your cervix to check that no lumps and bumps are distorting the uterine cavity (the inside of the uterus). During the procedure your doctor also takes small samples of the endometrium (the lining in the uterus). The endometrium changes in response to the hormonal changes that occur during the menstrual cycle and the samples are tested to make sure that your endometrium has the right appearance.

100 Pregnancy Tips

100 Pregnancy Tips

Prior to planning pregnancy, you should learn more about the things involved in getting pregnant. It involves carrying a baby inside you for nine months, caring for a child for a number of years, and many more. Consider these things, so that you can properly assess if you are ready for pregnancy. Get all these very important tips about pregnancy that you need to know.

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