医疗新知

When couples possess normal sexual life without conceiving babies is often referred to infertility. 

Infertile couples have to go to doctors for a thorough examination and evaluation: doctors would have to go through their past history and undergo careful observation of their ago, marriage life, contraception method, menstrual cycle, pregnancy, past surgery history, habits of smoking and drug usage, and history of infection. There are mainly three categories of attributions: 

1. Female factors－40%
   (1) abnormal ovulation and imbalanced hormone 
   (2) pelvic adhesion or tube and ovary-related surgery adhesion
   (3) endometriosis
   (4) cervical mucus: the function of the cervical mucus is to promote sperm’s entering into uterine cavity and further into the fallopian tube.
2. Male factors－30%
   (1) alcohol, cigarette, drug, and toxic environment are attributions to the quality of the sperm 
   (2) descending testes during childhood
   (3) puperty parotiditis infection
   (4) history of urology surgery: hinders ejaculation
   (5) radation and chemical therapy also affect sperm production and motility.
3. Common factors－20%

Doctors often have to evaluate both husband and wife’s physical condition; for example, if the wife has irregular ovulation and the husband has low sperm motility, they then can be troubled by the infertility. 

1. Female:
   (1) Basic body temperature: a good indication for ovulation time and follicular phase duration 
   (2) Level of serum progesterone: 5~10 days before menstruation, a blood test can reveal whether there is normal function of ovulation or hormone levels.
   (3) A serial of systematic ultrasound helps detect ovulation status. 
   (4) Home test kit (ovulation test kit ): is used for detecting ovulation date 
   (5) Hysterosalpingraphy (HSG): is the assessment for uterus abnormality and fallopian tube patency 
   (6) Laparoscopy diagnosis: doctors would make a further arrangement if there is abnormal HSG and speculations of congested fallopian tube.
   (7) Endocrine blood tests and pelvic examination
2. Male
   (1) The simplest and most basic assessment is sperm analysis.
   (2) hormone blood test
   (3) anti-sperm antibody test
   (4) Evalution of external genital appearance

First of all, a test tube baby does not grow up in a test tube. After the patient receiving ovulation medication and followed by ultrasound, follicle was extracted from the ovary through vagina under the guidance of ultrasound. Afterwards, egg and sperm are fertilized in the test tube for 2 days before transferred back to the uterus. 

The following patients could undergo treatment of test tube baby: patients of 

1. The resection or complete occlusion of the bilateral fallopian. 
2. Severe endometriosis
3. Low or no sperm
4. unexplainable infertility

Compared to normal pregnancy, such a treatment does not increase the chances of congenital anomaly. 

1. Despite successful ovulation induction, the egg retrieval procedure could still be hindered by severe pelvic endometriosis.
2. Intra-cytoplasmic sperm injection is now utilized to increase fertilization rate to resolve the problem of: (a) inconceivable rate despite the successful egg retrieval and (b) abandoning conceived egg for it is unable to split. 
3. Though embryo is successfully implanted into uterus, the 30-40% pregnancy rate is what troubles the doctor and mother-to-be the most during the entire process; so it is the key factor that researchers worldwide are craving to crack in order to effectively improve the problem.  
4. The miscarriage rate of the test tube baby is higher than naturally conceived pregnancy. Thus, high dosage of progesterone supplement is necessary. There is approximately one in six couples, conservatively estimated, suffering from complication of infertility. The current reproduction technology is helpful to one-third of couples and its breakthrough allows us to understand infertility better. With the knowledge, physicians are more skillful at assisting couples dealing with their mental and physical state and condition; moreover, they can be more financially planned to have the confident and courage of overcoming infertility.