Couples are now more likely to attend a doctor much earlier with queries about
infertility than would have been the case in previous generations. The couples
of today have grown up in an era where they have the power to plan their pregnancy.
They can choose to avoid becoming pregnant through the use of contraceptives
and may plan to defer conception until they have secured a nice home for themselves
and can provide a warm and comfortable environment in which to rear their child.
Given the fact that a couple can switch off their fertility very easily it
can be a tremendous shock to find that they are not succeeding in getting pregnant
at the time when they had planned for this to happen. There is a strong emotional
undercurrent in every case of infertility and the couple and their doctors ignore
that force at their peril.
Many couples see their family doctor as the gatekeeper who is simply there
to give them a referral letter to see a specialist. They may fail to appreciate
the potential that exists in this initial encounter. There is much that can
be achieved at this first consultation, which should not be rushed.
Drink and work stress
Simple questions need to be considered. How long have the couple been sexually
active together? Is sexual intercourse mutually satisfactory? Is there any suggestion
of a gynaecological problem? Do the couple both have normal genitalia? Are they
drinking too much alcohol? Is intercourse taking place when they are both stressed
out and exhausted after a busy week at work?
Basic questions need to be asked at this early stage and the focus of attention
must be on the couple because either or both of them could be infertile. I have
known of several cases in the past where the woman underwent a series of hospital
investigations before the penny dropped that it could be her male partner that
was infertile. I have also encountered a situation where the couple embarked
on a series of investigations, which turned out to be inappropriate because
the difficulty was in their relationship and not in their respective reproductive
We tend to have images of microscopes and complicated technology when we think
of infertility investigations and often overlook the value of simple observation.
Not many people realise that the physical size of the males testicles
are a reasonably accurate predictor of infertility. Infertile men tend to have
small testicles with resulting low sperm counts.
'Infertility treatment can result in the most wonderful prize of delivering
a normal healthy baby'.
The family doctor can advise and assist with a whole range of simple options
that do not require being referred to a 'high tech' centre. Sperm tests can
be organised through the GP as well as a variety of male and female hormone
analyses that can be performed on a small sample of blood.
The underlying message in what I am saying is that there is a great deal that
can be done by the GP and people should try to be patient. Sometimes the diagnosis
of infertility can be made in general practice and there is no immediate pressure
to rush off and see a specialist.
Experience has taught me that it is important for the couple to pause at each
hurdle along the way before proceeding. For example, if it is established that
the man has a testicular problem this fact should be absorbed first before proceeding
on to further investigation and treatment. Embarking on the next stage should
take place in the full knowledge of the possible outcomes and should take place
without coercion or subtle blackmail.
I have known couples to damage their relationship because one of them came
under pressure from the other to get on with the next stage despite some slight
misgivings about proceeding.
Having established a diagnosis it is important for both partners to be comfortable
with the treatment plan. This is a process that the couple should be in control
of. I have dealt with a situation where artificial insemination was considered
to be the best option for a couple but the man was not comfortable with that
choice. He declined and the couple have remained childless but together to this
day. I think they made the right choice for them.
I have also observed that infertility investigations and treatment can expose
some serious cracks in a relationship. Several years ago I recall giving the
results of a normal sperm test to a couple. I saw the man in a completely different
light when he said: 'well thats me out of the frame'. I was not surprised
when some time later the relationship broke up. Interestingly enough they separately
went on to new relationships both of which produced normal healthy babies.
It is important for couples to feel the power to stop the process at any time.
This is especially so when undergoing treatment. Sometimes a couple need to
take a holiday from infertility treatment. The process may not be physically
arduous in comparison with other treatments but it can be more draining than
most. It can be particularly emotionally draining if the treatment has been
going on for months with initial high hopes that are cruelly dashed when the
slightly overdue period arrives late. More than once I have heard women describe
how the period arrived just when they were beginning to hope that their dream
might be about to be realised.
Infertility treatment can result in the most wonderful prize of delivering
a normal healthy baby. The preceding months or years of investigation and treatment
quickly evaporate when the parents see their newborn baby for the first time.
Overcoming the problem of infertility can be compared to an exciting voyage
where there can be moments of fear and excitement, hope and despair before the
exhilaration of completing the journey successfully. It is not a journey for
the faint-hearted. It requires courage and determination and can severely test
In recent years there has been a virtual explosion of new technology for dealing
with the problem of infertility. It would be very easy to be mesmerised by the
science and overlook the emotional dimensions that are entwined with this problem.
Infertility can be a devastating loss that cannot be remedied in every case.
Technology alone is no solution for such people.
Written by Dr Leonard Condren, medical editor of irishhealth.com