4. Comments on the counseling of the couple
Re 1) Measuring the body temperature in the morning is recommended by DSOG (Danish Society for Obstetrics and Gynecology) as a way to teach women more about their menstrual cycle. For anovulatory women and women with a menstrual cycle of more than 35 days this makes no sense. The diagnostic certainty is very low.
Re 2) HSG can reveal obstructions, fibroma uteri, etc. Many clinics consider this examination fundamental prior to referral to hospital. It is important to note that 30% of the HSG results can be incorrect.
Re 3) The serum progesterone analysis can be made at the same time as 1) and will demonstrate whether there has been an ovulation. Values of more than 20 nmol/l is a certain evidence of ovulation.
Re 4) - see male infertility. Often a result from a sperm count states a lot of figures. In general, a sperm specimen is normal if it contains more than 15 mill. motile sperm cells per ml and more than 40% have a normal appearance. If antibodies are detected, the patient often has a problem.
Re 5) If women in more than one menstrual cycle have increased values of serum LH and serum FSH (more than 10 IU/l) their chances of conceiving are very reduced at any kind of infertility treatment.
5. Conclusion of the evaluation program
On the basis of the above parameters it is possible to advise the couple. It is important to give information about the various forms of treatment:
A slight hormone stimulation and intrauterine insemination (IUIH) in cases of unexplained infertility or anovulation.
IVF (In Vitro Fertilization) treatment for couples who have had 3 IUIH treatments and couples with known uterine tubes factor.
ICSI treatment for couples with severely reduced sperm quality
All couples must be informed about other possible treatments, such as sperm donation, egg donation (in case of increased FSH), and adoption.
The public fertility clinics for treatment of infertility:
that it is medically possible and correct to treat the couple
that the couple has an established relationship and has been living together for a minimum of 3 years
that the couple has no previous children together
that the woman is below the age of 37 at the time of referral (when the woman is 40 years old, the referral papers will be cancelled)
Lesbians are not treated
Guidelines for referral to private clinics that it is medically possible and correct to treat the couple that the couple has an established relationship and has been living together for a period
no woman beyond 45 years of age can be treated