Unexplained infertility and acupuncture
Infertility is usually defined as the inability to conceive after 1 year of regular unprotected intercourse. But for women older than 35 years the time will be shorter to for 6 months. The couple need to be assessed clinically
A standard infertility evaluation is performed both for men and women and includes a semen analysis, assessment of ovulation, a hysterosalpingogram, and tests for ovarian reserve and laparoscopy. When the results of a standard infertility evaluation are normal, a diagnosis of unexplained infertility will be made. Approximately 15% to 30% of the couple has unexplained infertility.
Semen analysis is test for evaluating the sperm. Here is the normal range of semen analysis as WHO guidelines. Volume 2.0-5.0 ml, pH 7.2-7.8, sperm concentration 20×106/ml, total sperm counts more than 40×106 spermatozoa, motility ≥ 50% with forward progression or ≥ 25% with rapid linear progression within 60 min after collection, morphology greater than 50% with normal morphology, viability, greater than 75% live, white blood cells less than 1×106/ml, fructose greater than 13 mol/ejaculate. Ovulation issues are present in 40% of infertile women and 15% of couples with infertility. It shows menstrual disturbances in many women. Other tests are available for assessing ovulation problems including basal body temperature (BBT) recordings, urinary luteinizing hormone (LH) ovulation predictor kits, mid luteal serum progesterone testing. Endometrial biopsy to assess for secretory endometrial development, though it is not recommended now. BBT recordings are the least costly tool in a reliable patient. Ovulation predictor kits are useful for women who do not have very long menstrual cycles and can be used by couples to appropriately time intercourse. Mid luteal progesterone levels are measured around day 21 in women with regular (∼ 28 day) cycles. However, they are often poorly timed if they are drawn on cycle day 21 in women with irregular menses. In such women it is better to use an ovulation kit and measure the progesterone levels 7 to 8 days after the LH surge is detected. Assessment of the uterine contour and the tubal patency is an integral part of the basic infertility evaluation and may be achieved by hysterosalpingography (HSG).
How to improve fertility
Life style change is a must including stop smoking, losing weight, reducing caffeine and alcohol consumption etc. Good balanced diet to get enough proteins, vitamins and minerals etc.
IUI: Intrauterine insemination involves the placement of washed sperm into the uterine cavity around the time of ovulation.
COH plus IUI: COH, with or without IUI is used in the treatment of unexplained infertility.
IVF/ICSI: The most expensive, but also most successful treatment of unexplained infertility consists of the spectrum of assisted reproductive technology including IVF, with or without ICSI.
Acupuncture: Acupuncture is used by many women with unexplained infertility. It can help these women conceive naturally or assist other treatments to succeed such as IVF.
References
A Quaas & A Dokras (2008) Rev Obstet Gynecol, 1: 69–76.
A standard infertility evaluation is performed both for men and women and includes a semen analysis, assessment of ovulation, a hysterosalpingogram, and tests for ovarian reserve and laparoscopy. When the results of a standard infertility evaluation are normal, a diagnosis of unexplained infertility will be made. Approximately 15% to 30% of the couple has unexplained infertility.
Semen analysis is test for evaluating the sperm. Here is the normal range of semen analysis as WHO guidelines. Volume 2.0-5.0 ml, pH 7.2-7.8, sperm concentration 20×106/ml, total sperm counts more than 40×106 spermatozoa, motility ≥ 50% with forward progression or ≥ 25% with rapid linear progression within 60 min after collection, morphology greater than 50% with normal morphology, viability, greater than 75% live, white blood cells less than 1×106/ml, fructose greater than 13 mol/ejaculate. Ovulation issues are present in 40% of infertile women and 15% of couples with infertility. It shows menstrual disturbances in many women. Other tests are available for assessing ovulation problems including basal body temperature (BBT) recordings, urinary luteinizing hormone (LH) ovulation predictor kits, mid luteal serum progesterone testing. Endometrial biopsy to assess for secretory endometrial development, though it is not recommended now. BBT recordings are the least costly tool in a reliable patient. Ovulation predictor kits are useful for women who do not have very long menstrual cycles and can be used by couples to appropriately time intercourse. Mid luteal progesterone levels are measured around day 21 in women with regular (∼ 28 day) cycles. However, they are often poorly timed if they are drawn on cycle day 21 in women with irregular menses. In such women it is better to use an ovulation kit and measure the progesterone levels 7 to 8 days after the LH surge is detected. Assessment of the uterine contour and the tubal patency is an integral part of the basic infertility evaluation and may be achieved by hysterosalpingography (HSG).
How to improve fertility
Life style change is a must including stop smoking, losing weight, reducing caffeine and alcohol consumption etc. Good balanced diet to get enough proteins, vitamins and minerals etc.
IUI: Intrauterine insemination involves the placement of washed sperm into the uterine cavity around the time of ovulation.
COH plus IUI: COH, with or without IUI is used in the treatment of unexplained infertility.
IVF/ICSI: The most expensive, but also most successful treatment of unexplained infertility consists of the spectrum of assisted reproductive technology including IVF, with or without ICSI.
Acupuncture: Acupuncture is used by many women with unexplained infertility. It can help these women conceive naturally or assist other treatments to succeed such as IVF.
References
A Quaas & A Dokras (2008) Rev Obstet Gynecol, 1: 69–76.
