| Basic information needed: Has the couple been together for sufficiently long time? Are they missing the fertile period? Are they using contraceptive? Infertility should be considered if a couple having 1 year (or 6 months at least ) of regular coitus, inn the fertile period, without contraceptives, have failed in conception. Ask about sexual dysfunctions like dyspareubua, Premature ejaculation or impotence. Tackle it first before any active treatment. Examine and investigate both partners simultaneously, both partners simultaneously. If genitalia are normal ask for: Sperm count in Male Ultrasonography and tubal patency in Female. Husband with a low sperm count: If sperm count is < 60 million or motility is poor, Tab. MAmofen 10mg bd x 3-6 months ot Tab. CLOFERT 25mg HS x 35 days + 5 days rest x 3-6 months. Advise abstinence of 3 days before the fertile period of the wife. Advise measures to keep scrotal temperature low. Wear loose cotton underwears. Now tight pants. Immerese scrotum in a pan of cold water x for 10 mins x 2 times/ day (during bath and at night) If sperm count is < 10 million: Refer to infertility centre, for intra-uterine insemination with sperm concentration techniques, which gives excellent results. If sperm count is zero: Refer to endocrinologist, If there is hormonal deficiency or obstruction in vas, it can be treated. But If there is primary agenesis of sperms, then the couple may opt for adoption or Artificial insemination donor. If semen contains pus cells: Tab. Norflox 400mg tds x 10 days If left spermatic cord shows varicocele: Refer to a surgeon for operation. Wife with normal pelvic anatomy and patient tubes: Advise about ovulation cycle, Fertile period and timing of inter course. Tab. Clofort 50mg daily x 5 days x from 3rd day of M.C and coitus daily after 12th to 16th day, Exact day of ovulation may be detected by ultra sonography. Tab. Evion 400mg OD x 3 months Tab. Beplex forte 1 OX x 3 months Treat cervix erosion, PID etc. if prestnt. For all other forms of treatment, Refer to a gyneacologist. If the tubes are blocked, attempt is made to clear the tubal block by Laproscopy, Hysteroscopy or surgery. If tubal block cannot be corrected, then in-vitrofertilization (Test tube baby) is the treatment of choice, second choice being adoption. The role of the G.P is mainly to cheer up the couple, give them confidence and keep them tension free during the treatment perion which is prolonged and invasive. About 10%of couple are infertile. Very very few couples require sophisticated techniques like GIFT, test tube baby etc. But a much large number of couples require just what is mentioned above a few drugs, proper sec counseling and sex education and reassurance. During investigation of an infertile couple, semen report of the Husband must bee seen before invasive investigations in the wife are advised. Tab. CLOFERT Tab. Norflox Tab. Clofort Tab. Evion Tab. Beplex CLOFERT MAMOFEN |
