Pro-Fertility Counselling

Pro-Fertility Counselling

counsel

Pro-Fertility Counselling

January 2019

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:

  • measurement of individual's capacity to form eggs by hormone testing (anti Müllerian hormone)
  • pelvic sonography in women
  • sperm analysis in men,
  • and assessment of reproductive risk factors in both partners.

 

 

Why is It Needed?

The FAC clinic includes a research programme with the goal to improve prediction and protection of fertility. Specialised clinics for individual assessment and counselling need to be established to provide:

  • knowledge of fertility status,
  • knowledge of reproductive lifespan (women) and
  • pro-fertility advice.

 

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 are able to 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 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 freezingshave 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 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 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 menwith 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 a pregnancy was only 8% per month with a sperm concentration below 10 million/ml, but 25% per month with a sperm concentration 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 extreme 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.