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How I Do it? - Fertility Practice by ROZA OLYAI(Gwalior) Dr Roza Olyai Inability to conceive is one of the common problems among the many conditions bringing a woman to a gynecologist for treatment. In daily practice I have observed that often the lady may come for the first consultation with another female relative often her mother, sister, mother-in-law, sister-in-law etc. In such cases, the husband is often unavailable during this initial consultation. I strongly feel that social problems often need to be tackled in such cases as many a male partner refuses to acknowledge his potential role in the situation. With all this in mind, I give much importance to husband’s presence in all first visits. Whenever the couple are available together for consultation, I take detailed history regarding complaints, menstrual pattern, relevant occupational details, previous unsuccessful pregnancies which they may have discounted, history of any instrumentation such as D&C for diagnostic or therapeutic purpose, medical history regarding tuberculosis, diabetes etc. Sexual history gives me important additional information in such couples to pinpoint problems such as infrequent or irregular intercourse, premature ejaculation, dyspareunia etc which can have a direct bearing on fertility potential Since some times questions are difficult to ask from the couples in our busy practice when in OPD as either the staff is moving around or the patients may come with their other relatives, hence, I have started giving them a form with questions like private coital history in detail to be filled up by the husband and wife together at home which they return to me on the next day. This I feel gives freedom to the couple to explain their problems in detail. After reading their form I write down the positive points in their case paper and tear down their form in order to keep their privacy. Next I try to evaluate all previous reports of investigations as well as the treatment details if available, which the couple has got done earlier during the course of undergoing treatment After history and a detailed clinical examination of the couple, I always explain in simple terms, the normal process of reproduction utilizing visual aids such as simple diagrams or pictures of the reproductive system. A visual impression accompanied by a short description of the various factors which can be responsible for difficulty in conception helps to motivate the couple to cooperate in treatment. A basic understanding of the reproductive process also explains the need for investigations as indicated by history and clinical examination. I usually give baseline investigations to the couple when they first approach me for the treatment of sub-fertility. I feel that simply making a long list of investigations without adequate explanation of the role of such investigations is not helpful in their management. I strongly feel that, individualizing the approach to management of the couple goes a long way in arriving at a diagnosis and also helps in reducing the financial burden they have to bear. I even tell them about the limits of various treatment modalities and discuss the optimum number of trials of a particular drug or intervention, keeping guidelines for the patient’s safety in mind. I usually give folic acid supplementation (if not advised earlier or stopped by the couple) in such women trying for conception with a simple explanation of its utility in healthy child-bearing.On the very first visit, I emphasize on the importance of regular follow up and a dedicated, timely approach to following instructions given to them. I my experience I realized that using such an approach while treating couples with the problem of sub-fertility helps to develop confidence in them as well as clear any doubts or misconceptions they may have harbored. Often I find that these couples are frustrated and tired after long drawn-out treatment, I have experienced that a patient hearing and a sympathetic, yet systematic approach can go a long way in helping them tackle their situation more optimistically with better chances of a favorable outcome. |
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