Basic Management of Infertile couples.

The delay in having children may be due to one or several causes. The initial approach should in discovering the cause or causes of the problem to be able to solve them. The most frequent causes in women are lack of ovulation or obstructed tubes (the ducts where ovum and spermatozoa meet). In men, alterations in number and quality of spermatozoa may be caused by several conditions.

Sometimes, the couples already know what is wrong and come for a specific treatment: medical, surgical or assisted reproduction treatment. In other cases they need a complete evaluation. Usually they are overwhelmed by the long period of time they have endured without results. In some cases, they may feel frightened and hopeless about the possibility of never being able to have children.

The initial appointment is essential. Both members of the couple should attend. To get the most out of the consultation it is better to have a summary of what they have gone trough: lab tests, sonograms, x rays, prescriptions and a report of any surgical procedures. The medical-patient relationship is crucial; they should feel that he (or she) is really interested in helping them. The medical doctor should listen carefully and be able to make intelligent questions. He (or she) should be able to understand what they haven’t said with words. The physician will try to discover what worries them most and do his (or her) best to get their cooperation. If the couple perceives a compassionate and professional doctor, that is organized and certain of what he (or she) is doing, the relationship will be a better one.

The data in the medical history provided by the couple may suggest ovulation problems (irregular menses, use of birth control pills to regulate menses, previous diagnosis of polycystic ovaries, lack of menses unless she takes medications, fluid coming from the breasts, etc.) or obstructed tubes (repeated genital infections, previous pelvic surgery, endometriosis, etc). Important data for men include sexually transmitted diseases, environmental hazards, testicular trauma, endocrine diseases, venous engorgement in the testes, etc.).

Once the medical history is provided, the examination is focused towards the suspected cause without neglecting a complete evaluation. Lab tests are indicated, which include hormonal levels in blood. These tests provide valuable information about ovulation and the capacity of ovaries to remain functional. For the tubes and uterine cavity a very useful tool is a hysterosalpingogram, an X-ray with a contrast medium instilled trough the cervix. Some times a laparoscopy is required. In men, hormonal measurements, and an analysis of the semen are necessary. All of these tests are explained in more detail in this same web page.

These studies allow us to select the best treatment in each case: ovulation induction or, laparoscopy to correct obstructed tubes and treat endometriosis. The male partner may also need medical or surgical treatment alone or at the same time.  These issues are dealt extensively in this same web page.

If after a complete evaluation, everything is normal and the couple is young, it is OK to try intrauterine inseminations with semen of the male partner and perform a minimal ovarian stimulation for the female partner. This allows the spermatozoa to concentrate and prepare, in order for a better timing among ovulation and the inner lining of the uterine cavity (endometrium). This gives the ovum a better chance to get fertilized and to reach to a more receptive endometrium.

Couples that should not delay assisted reproduction are: failures to medical or surgical treatments or infertility, women older than 35, irreversible damage to the tubes for infection or endometriosis, previous vasectomy or severe spermatozoa alterations. Immediate consultation is recommended since in most cases preparation before assisted reproduction is required to get a better prognosis.

Each of these subjects are treated separately in this same web page and will be translated to English shortly, in the meantime you can get excellent information from reliable sources like ACOG or ASRM.  In conclusion, a good medical-patient relationship is as important as technological advances for the treatment of infertility. The medical doctor should be compassionate, professional and with appropriate skills to be able to listen, explain, help to make intelligent choices to improve your chances of having the child you long for.


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Dr. Efraín Pérez Peña

Egresado de la Escuela Médico Militar, México DF. Residencia en el Hospital Central Militar, México DF. y en el Boston City Hospital, Boston, Mass. Post-grado en Boston, Filadelfia y Londres (Universidades de Harvard, John Hopkins and London). Diplomado por elAmerican Board of Obstetrics and Gynecology.  Maestría y Doctorado en Ciencias.U de G. Profesor Examinador por el Consejo Mexicano de Ginecología y Obstetricia en la Especialidad de Biología de la Reproducción Humana. Profesor Titular del Diplomado en Biología de la Reproducción Humana avalado por la UNAM. Profesor Titular del Diplomado en Endocrinología Reproductiva, Infertilidad y Reproducción Asistida avalado por la U de G. Director del Comité de Educación y Profesor del Curso PEC Online de la Red Latinoamericana de Reproducción Asistida. Ex Jefe del Departamento de Ginecología y Obstetricia y de Enseñanza e Investigación del Hospital Militar de Guadalajara. Especialidad Básica en Ginecología y Obstetricia. Con especialidad en Endocrinología de la Reproducción, Infertilidad y Reproducción Asistida. Pertenece a la Academia Nacional de Medicina, Colegio de Gineco-Obstetras del Edo de Jal, a la Asoc Jal de Endoscopía Ginecológica, a la Asociación Mexicana de la Medicina de la Reproducción, a la European Society of Human Reproduction and Embryology, la American Society for Reproductive Medicine, la World Association of Reproductive Medicine, American College of Obst and Gyn  y American College of Surgeons. Autor de 5 libros de Infertilidad, Endocrinología y Reproducción Asistida. Editor del Manual de Procedimientos Clínicos en RMA de la RED LARA. Editor del libro para pacientes de la AMMR  y/ Coautor en libros y artículos de revistas nacionales y extranjeros

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El Instituto Vida, con más de 25 años de experiencia en el manejo avanzado de parejas infértiles, cuenta  con cinco sedes : León, Guadalajara, Matamoros, Mérida y Ciudad de México ( y próximamente otras dos sedes abrirán en Tijuana y Querétaro) dirigidas por profesionales de  reconocido prestigio nacional e internacional.

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