Patient Counselling for Infertile Couples

A couple suffering from infertility will face complex issues which span biological, psychological, social issues.

 Counselling of infertile couples include:

  • Information gathering and analysis:Providing sufficient information about the medical aspects of the treatment is primarily the responsibility of the Infertility Specialist In Chennai. To obtain more information concerning the social and emotional implications of the infertility treatment
  • Implications and decision-making counselling:It aims to enable the person or people concerned to understand the implications of the proposed course of action for themselves, for their family and for any children born as a result.
  • Support counselling:Support counselling aims to give emotional support to patients experiencing distress. Distress can be caused by the frustration of the desire for a child, social and family pressure as well as by the reproductive technology employed and its limited success rate. Such distress motivates the need for emotional support from many sources (such as family members, partner, and support groups). The treatment process will also provoke periods of particular distress that might increase the need for support counselling.
  • Therapeutic counselling:can focus on reflection of individual problems and (family) history, the acceptance of the situation, the meaning and impact of infertility, including grief work, work on alternative life and self-concepts for the future, the development of coping strategies and strategies to minimize distress, problem and conflict solving, and/or specific issues such as sexual, marital and other interpersonal problems.

WHO IS LIKELY TO NEED COUNSELLING:

  • Patients who use donated gametes, surrogacy and/or adoption to achieve parenthood.
  • Patients who experience great distress. Distress most commonly shows itself as depression or anxiety, but it can be manifested as any negative affective reaction. Patients often consult the counsellor because distress reaches a level at which it interferes with daily activities.
  • Patients considered to be at risk because of their psychological history or presenting profile.
  • Patients who require some form of genetic counselling as part of their fertility treatment (i.e. pre-implantation genetic diagnosis). These patients may wish to avoid transmitting a genetic disorder to their offspring, to screen donated embryos and/or to acquire information about a future child (e.g. sex selection).

Any patient can use professional counselling given by the Best Fertility Hospital in Chennai and all patients should be assisted in obtaining the help they feel they need. However, there are several groups of patients who needs specialized psychosocial care. They include:

If the couple is married for less than a year and comes for treatment, then Reassurance is the only treatment. A Couple is considered for treatment only after 1 year of continuous Unprotected several Intercourse.

If the Couple is married for more than 1 year then the evaluation has to be started.

The main Issues in Infertility which has to be checked are

  • Does the women ovulates regularly or not
  • Is the Sperm count of the husband is normal
  • Are the tubes patent.

If these factors are normal, then Couples can be advised to try naturally and Reassure the patient.

If the women is having regular cycles, it doesn’t mean that she is ovulating correctly. The menstrual cycle and the ovulatory cycle are different. So follicular study will be useful to check ovulation. So FMS (follicle maturation study) done on Day 12, 13, 14 may be helpful to check for Ovulation.

For Few patients, follicle size reaches to appropriate required size but there won’t be rupture .So Prolactin levels have to be checked. In case of Hyperprolactinemia, it interferes with Egg rupture, so it has to be treated.  Nowadays PCOS is a major Issue in many females. So the only problem is poor follicle development (Dominant Follicles), these patients require ovulation induction drugs for egg development and they can try naturally. Some patients have hemorrhagic cysts which is bleeding into cysts, they resolve spontaneously.

Secondly Tubes has to be patent to conceive naturally .It has to be checked on Day 7 or Day 8 of the menstrual cycle at which endometrial thickness is minimum for the dye to travel easily and reach the tubes.

In male patient we should check several parameters in semen analysis:

  • Concentration
  • Motility
  • Morphology

If any abnormality in these parameters is seen, it has to be corrected.

If the patient is ovulating, tubes are patent and semen analysis of the husband is normal, then couple can try naturally. Even after normal ovulation and normal patent tubes & normal sperm count, few couples won’t conceive, then we can counsel the patient for IUI which is the best option.

In IUI procedure, sperms are introduced inside women’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tube and subsequently increases the chances of fertilization.

IUI is useful in

  • Unexplained infertility
  • Ejaculation dysfunction.
  • Hostile Cervical Condition

So we can try for 3 to 4 cycles of IUI , even after it is not successful, then Diagnostic Hysterolaparoscopy is the option to check the patency of tubes.

Hydrosalpinx, Endometriosis which is main cause of adhesions inside. If fallopian tubes are adhered, then chances of natural &IUI are less.

If tubes are normal, then we can proceed with further IUI cycles.

If there is hydrosalpinx or tubal block or severe endometriosis, ICSI is the best option.

If the motility is very less, then ICSI is the best option in which we directly inject the sperm inside the oocyte. The Difference between ICSI and IVF, is that in IVF the sperms are placed around the oocyte, sperms has to travel and penetrate themselves into oocyte.

In Elderly women, the quality and quantity of oocytes is very poor. So AFC & AMH should be done. If the Antral follicle is very low and AMH is low, then donor oocyte is the preferred treatment. In case of less sperm count, then donor sperms is advised.

With Donor sperms, we can go for IUI if the tubes are patent. If tubes are blocked, then ICSI with donor sperms has to be done. In case of Azoospermia, testosterone & FSH has to be checked. If the Blood values are normal range, then we can go for testicular biopsy. If Best Fertility Centre in Chennai collects any sperms they can be frozen and used for further treatment in ICSI.

 

 

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