By Dr. Sonu Talwar
What does it Mean?
Today, delayed childbearing, low total fertility rates and increasing use of social oocyte freezing create a need for pro-fertility initiatives. This is done for all couples & not only the infertile couples to know how fertile they are & if they should be visiting a fertility specialist soon.
The Fertility Assessment and Counselling (FAC) clinic offers individual counselling based on a clinical assessment including:
Why Is It Needed?
The FAC clinic includes a research programme to improve prediction and protection of fertility. Specialised clinics for individual assessment and counselling need to be established to provide:
Who Should Run the Clinic?
Addressing these issues is often more challenging than treating infertile patients. Therefore, fertility assessment and counselling should be developed by specialists in reproductive medicine. The concern is how precisely we can forecast future reproductive problems.
Relevance in Present Scenario: Why?
Firstly, it is well known that population with higher proportions of well-educated women have lower total fertility rates. Also, fertility awareness is inadequate in the general population. Secondly, the possibility of egg freezing may contribute to the further postponement of childbearing.
Social egg freezing is advertised on the Internet as 'Eggsurance.com' or 'Retrievefreezerelax.com' suggesting that women who undergo egg freezing have insurance and can relax after the procedure, as their future fertility will be safe.
Lastly, the long-term use of oral contraceptives may conceal the true ovarian reserve. This concealment may motivate them towards a clarification of their status. The FAC clinic can help to identify OC users with a low ovarian reserve and those with underlying ovulation disorders.
Also female with known risk factors like-Age more than 35 years, history of surgery on the abdomen, history of endometriotic cyst or fibroids should come for counselling early as they are at high risk for infertility.
Can we predict later infertility in men?
For the men with known risk factors for subfertility evaluation should be done earlier. The man brings a sperm sample and a sperm analysis is performed(including volume, concentration, total sperm count, percentage motility and progressive motility). The likelihood of pregnancy falls with decreasing sperm count & motility.
The likelihood of pregnancy was only 8% per month with a sperm concentration below 10 million/ml, but 25% per month with a sperm concentration of around 40 million/ml. We realize that one has to be cautious when estimating a man's fertility from just one semen analysis. A repeat full sperm analysis should be performed.
In men with extremely low sperm count, we inform the couple that they should not waste too much time trying to conceive naturally. If known risk factors or lifestyle factors that could predispose to male infertility are present, we advise accordingly.