February 24, 2005 • ISSUE 18 / VOLUME 1

Timeliness is important in fertility evaluation

By Kenneth VU, M.D.
Medical Director
Hawaii Center for Reproductive Medicine and Surgery

Infertility is a complex medical, emotional and social condition that affects more than 6 million reproductive-age couples in the United States.

Successful treatment can be achieved through a disciplined approach in the safest, but most efficient and cost effective manner possible. To achieve success, it is very important that a timely and complete evaluation of both partners be performed. The frequently ignored psychological toll of repeated treatment failures must also be considered.

Although infertility is generally viewed in our culture as "a female problem," about 45% of infertile couples have male factor as a contributing cause. It is now recommended that an infertility work up should begin with the male, as early detection of significant dysfunction may avoid costly and invasive procedures and treatments, and save precious time.

The evaluation of the male partner starts with a semen analysis. When abnormal results are indicated, the couple should be referred to a reproductive endocrinologist and/or urologist for further evaluation.

In the evaluation of the female partner, a well-orchestrated work-up can be completed in a menstrual cycle. Together with the male data, a definitive treatment plan may be mapped. Ovulation should be documented, and a thorough history, physical examination, and pelvic ultrasound, should be conducted.

The physical examination and pelvic ultrasound will help identify structural abnormality requiring appropriate surgical intervention or alternative treatments. Ovarian reserve, an evaluation of egg quality and quantity, is among the most important prognostic indicators in predicting treatment outcomes, and in counseling of infertile couples especially in women over 35 years old. Other endocrine evaluations should be performed concurrently to rule out other underlying dysfunction.

The infertility evaluation should be thoroughly and rapidly accomplished and treatment should occur quickly and efficiently to maximize the "window of opportunity" that exists. Couples should be compassionately, but appropriately counseled of their prognosis and options.

For more information, contact The Hawaii Center for Reproductive Medicine and Surgery, 941-3322, 261-4166 or e-mail drkvu@yahoo.com.