What to do if you cannot have a baby
The first step is getting the medical history (record of illnesses, surgeries, hazards at work, and bad habits). At this stage, patients' willingness to provide information is essential, as many patients consider this information non-essential and overlook them when reporting. There are numerous situations in medical practice when the patient hides the truth (for example, a woman doesn't want to speak about having an abortion or a man fails to mention a past sexually transmitted disease). In more than 50 percent of cases, a medical professional can give the right diagnosis and select therapy during the first visit based on medical records.
Male side
For many decades, the absence of babies in families was attributed exclusively to the woman’s health problems. However, as of today, more than 50 percent of infertility is related to a drop in the quality of semen. If a couple cannot achieve pregnancy, it is recommended to start by examining the man’s medical history.
Medical professionals receive the first set of data about the condition of a man's reproductive system based on the semen analysis. The number, mobility, and morphology (quality) of spermatozoa are of primary importance.
Here is an example of what positive test results look like:
- Concentration of spermatozoa in 1 mL—15 million or above
- Total sperm motility—40 percent or above
- Progressive sperm motility—32 percent or above
- Morphologically normal spermatozoa—4 percent or above
The next stage includes an ultrasound examination of the prostate, scrotum, and other organs and systems to look for medical clues.
After excluding the male infertility factor, the doctors will screen the woman.
Female side
The most frequent causes of female infertility include ovulation disorders, pathology of the fallopian tubes, and implantation disorders (failure to implant a fertilized egg in the uterine cavity).
First of all, it is necessary to make sure that ovulation is occurring. This is achieved with the help of home test kits, based on the same principle as pregnancy tests, or with the help of ultrasound diagnostics. In doing so, it is necessary to exclude the polycystic ovary as the cause of endocrine infertility, as it is the most frequent cause. Patients over 37 years of age should pass a test for ovarian reserve (the reserve of eggs, which is irreversibly decreasing with age).
Those patients, who should be screened for patency of the fallopian tubes and have a pelvic examination, are sent for laparoscopy.
The next stage of diagnostics includes assessing the uterus. This includes the ultrasound examination of the uterus (on the 5–7th day of the period), Pipelle endometrial biopsy, and hysteroscopy (in the presence of medical indications). The aspiration Pipelle endometrial biopsy is done on the second stage of the menstrual cycle to assess the endometrium on the 20–22nd day of the 28th-day cycle within the implantation window.
Meanwhile, diagnostics of the intrauterine pathology and its following treatment start from hysteroscopy. It can spot endometritis, intrauterine synechiae, and polyps of the uterine cavity as well as remove them. The tissue of the endometrium received during the biopsy can be further examined during an immunohistochemical study. It represents a highly informative way of assessing the endometrium's condition and determining the functioning of the receptors, which helps a doctor select an individual therapy for each patient.
When infertility of unknown origin has been an issue for five years or longer, or in the case of failure of vitro fertilization and/or lost pregnancy, it is advisable to expand the scope of the medical examination to identify causes for these disorders.
Even in the case of normal genotype, it is recommended in some instances to consult with a geneticist and expand the scope of the genetic research (molecular biological examination with the distribution of gene alleles).
Determining compatibility in couples under the system of histocompatibility of II class (HLA of II type) can be assisted by the immunogenetic test.
In case a woman has a history of lost pregnancies, it is necessary to consult with the hematologist and run a special test to identify the causes. Most often, during such tests, the doctors find hereditary or acquired thrombophilia (or both).
Overcoming infertility and achieving pregnancy in a short period of time can be possible only when following an individual approach and undergoing planned diagnostics and therapy measures. In doing so, it is recommended to have the diagnostics and treatment under one roof in a reproductive medical center with extensive resources.
