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  • Title: [How to advise an infertile couple].
    Author: Mongin C.
    Journal: Dev Sante; 1987; (69):4-7. PubMed ID: 12341929.
    Abstract:
    Infertility is a serious problem in many regions of Africa. In parts of Gabon for example sterility rates of 25% are not unknown. In the absence of contraception, 80% of couples will conceive within 1 year and 10% will do so at a later time without treatment. In 40% of cases, infertility is attributable to the male and in 20% both spouses play a role. The most important phase of an initial infertility consultation is getting a complete medical history, including age, duration of infertility, contraceptive usage, history of gynecological infections or pelvic surgery, and menstrual pattern. Whether the sterility is primary or secondary and the circumstances of any previous pregnancies should be determined. Other conditions such as bilharziasis should be ruled out. The husband should be asked about his urologic and general health. The clinical examination of the women should consider her weight in relation to height and any signs of infection or other anomaly that could explain infertility. Conditions possibly responsible for infertility should be treated if possible. If the results are normal, the woman should be instructed to record her basal body temperature. Hormonal treatment can be provided if the temperature curve is abnormal. 2 other common tests, sperm analysis and the postcoital test, require specialized laboratories and are not possible everywhere. If all the tests are normal, the couple should be reassured and instructed to return in several months if pregnancy has not ensued. Among other possible procedures are hysterography in case of a history of abortion or curettage and laparoscopy is there is there is suspicion of hydrosalpinx on hysterography, tubal patency is not confirmed by hysterography, or no cause of sterility is found after 2 years. Analysis of the levels of estradiol, progesterone, and prolactin can be used to assess the functioning of the corpus luteum. Infections cause a large proportion of cases of infertility; the struggle against infertility should thus begin with prevention of sexually transmitted diseases and tuberculosis.
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