Investigation of Infertility- The Despondent Woman

It's very heartening when I see women are subjected to all the pressure and treatment for pregnancy. The problem may be either related to the man or women. But most often only women have to bear the challenges of the treatment, such as Regular vaginal scans, hormonal blood tests and of all regular medication and injections.

Today I saw a young women who was 24 years old coming for consultation to my OPD.

So I started my series of Questions which are a part of the usual history taking process.

The answers, however, came as a shock to me.

I asked her what the issue was. She said she had not yet conceived

How long has she been married for? ---- 4 months!!

She has already done all the blood test as part of the Infertility workup.

And had already seen two consultants

Okay, I thought there must be some issue.

So I went through the reports and previous consultations and found nothing medically wrong.

So what is it?

Then I asked for her husband to come in, as he was not present, thinking that he must be waiting to be called.

But she had come with her .. Mother. And the Husband was not present for the consultation.

So I again repeated my question, but this time differently.

I asked her Why such an urgency .

With tears in her eyes, she said that her mother in law was forcing her to get pregnant since the first month of marriage. When asked if semen analysis was done as part of the work-up, She answered in a very unassuming tone that. IT WAS NOT DONE.

After more than 2 decades of being in practice What I still fail to understand is why is it always it the women who has to undergo the brunt of bearing the blame for not getting pregnant. When the male partner is not even available with wife during the first consultation.

It's very well-known that both men and women are equally responsible for conceiving and also for not conceiving.

When do we investigate couple for fertility issues?

We advise investigation only after one year of unprotected intercourse, where the women is less than 30 years of age and 6 months unprotected intercourse, for women more than 30 years of age.

Do couple need any investigation before conceiving at all?

As routine preconception counselling we do advice few investigation which would prevent complications during pregnancy like haemoglobin test, thyroid function test, and rubella screening.

Who has to be investigated first husband or wife?

As both are equally responsible both have to be investigated together. There are the battery of test to be done to investigate a woman but for a man, it's just one simple test semen analysis.

Why is there a prejudice when it comes to women being subjected to infertility treatment?

The general conception in many house hold is that if the couple has not conceived after trying for many months, the blame is usually put on the wife. This is not always the case and in such circumstances, the couple need to support each other rather than point fingers and play the blame game.

Why does the male partner shy away from getting tested?

In my personal experience, I have seen that many Men think that revealing that they have a low sperm count or low motility is like questioning their manhood. This is a very damaging misconception and can lead to lot of issues among the couple if not sorted out. The male partner needs to be counselled regarding the need to get tested for complete evaluation of infertility, and that the reports are completely confidential.