If treatable conditions are not found or genetic infertility is established, then reproductive technologies such as intrauterine insemination or in-vitro fertilisation may be used to help a couple conceive.
Q: I am 33 years old and my husband is 38 years old. We have been married for almost a year and have been trying to conceive.
Initially, I thought I was the cause of our inability to conceive as my period is not regular. My cycle is not a 28-day one. Instead, it is either a 30-day or a 32-day cycle.
I had been monitoring my basal body temperature but could not identify whether I was ovulating. Hence, I went to see a doctor. After examining me, the doctor prescribed three months of Clomid and told me to monitor my basal body temperature and continue to try for a baby.
With the help of medication, my cycle became regular. I continued measuring my basal body temperature and was aware of when I was ovulating. However, I am still not able to get pregnant. The doctor suggested that I get my husband to go for a sperm test.
The result indicated that my husband’s sperm count is on the low side. The doctor has given us two suggestions: Put my husband on medication or go for in-vitro fertilisation (IVF). Is there another way to improve my husband’s sperm count? Is IVF the only way for me to conceive?
A basal body temperature measurement is one of the many methods of monitoring ovulation.
The basal body temperature is the lowest temperature attained by the body during rest, usually during sleep.
The theory behind this method is that during the first half of a woman’s menstrual cycle, the basal body temperature tends to be lower.
Prior to ovulation, most women would experience a slight drop, followed by a rise, in basal body temperature.
The rise in basal body temperature is a sign that ovulation has already taken place. If the temperature remains high for more than three days, you can assume ovulation has occurred.
Most doctors would recommend intercourse during the drop in temperature just prior to ovulation.
When charting your basal body temperature, a special thermometer, which can record body temperature to 0.1 of a degree, is required.
It is also important to take your temperature at the same time every day and ensure that you have had at least three hours of sleep and have not smoked or eaten before taking a reading.
It would be useful to chart your temperature for several cycles to monitor your basal body temperature trend.
It is also useful to note that 20 per cent of normal ovulating women do not get a change in their basal body temperature.
But if you still do not conceive after several cycles, it would be prudent to visit your gynaecologist to see if there are any other problems.
Semen analysis is one of the most basic tests performed during the initial investigation for infertility in a couple. If the sperm count is low, sometimes further investigations can be done to determine the cause.
Some causes are treatable, such as varicocele (dilated veins in the scrotum), reproductive hormonal imbalance and chronic use of medication such as steroids.
Chronic disease such as diabetes, obesity and poor general health can also contribute to low sperm count. Increasingly, genetic abnormalities are being found in men with low sperm count.
These rare genetic abnormalities can account for 15 to 20 per cent of men with abnormal sperm count. However, in more than half of the cases, we may not find a significant treatable cause.
For these reasons, all infertile men with a low sperm count should be evaluated with a thorough history and physical examination.
This assessment should also include a measure of their reproductive hormones, including testosterone, and ultrasound assessment of their scrotum.
After this, it is not uncommon for doctors to prescribe lifestyle changes, offer medical therapy or recommend surgical treatment such as varicocele repair to correct and improve sperm count and augment natural fertility.
If treatable conditions are not found or genetic infertility is established, then reproductive technologies such as intrauterine insemination (IUI) or IVF may be used to help a couple conceive. In IUI, sperm is introduced directly into the woman’s womb at the time of ovulation. In IVF, the woman’s eggs are fertilised with sperm in a laboratory and the fertilised eggs are transferred to her womb.
Dr Seng Shay Way
Consultant obstetrician and gynaecologist at Raffles Fertility Centre at Raffles Hospital
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